Paced electrical alternans with syncope: Time for emergent pericardiocentesis?J Electrocardiol 2025 Sep-Oct; 92:154089.JE
Abstract
Left bundle branch area pacing (LBBAP) is now a common implantation strategy for both pacing and resynchronization based device therapies. While LBBAP has been (somewhat paradoxically) demonstrated to be effective in cases of preexisting left bundle branch (LBB) block, and criteria for LBB capture have been established; minimal focus has been towards the intrinsic refractory rate of the LBB. Herein, we demonstrate a case of LBBAP rate exceeding the refractory period of the LBB, resulting in alternating LBBAP capture and non-selective septal pacing. Implicit understanding of this physiology has important sequel for accurate assessment of lead placement during implantation.
MeSH
Pub Type(s)
Journal Article
Case Reports
Language
eng
PubMed ID
40812288
Citation
Downey, Michael C., and John S. Zakaib. "Paced Electrical Alternans With Syncope: Time for Emergent Pericardiocentesis?" Journal of Electrocardiology, vol. 92, 2025, p. 154089.
Downey MC, Zakaib JS. Paced electrical alternans with syncope: Time for emergent pericardiocentesis? J Electrocardiol. 2025;92:154089.
Downey, M. C., & Zakaib, J. S. (2025). Paced electrical alternans with syncope: Time for emergent pericardiocentesis? Journal of Electrocardiology, 92, 154089. https://doi.org/10.1016/j.jelectrocard.2025.154089
Downey MC, Zakaib JS. Paced Electrical Alternans With Syncope: Time for Emergent Pericardiocentesis. J Electrocardiol. 2025 Sep-Oct;92:154089. PubMed PMID: 40812288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Paced electrical alternans with syncope: Time for emergent pericardiocentesis?
AU - Downey,Michael C,
AU - Zakaib,John S,
Y1 - 2025/08/05/
PY - 2025/07/29/received
PY - 2025/08/03/accepted
PY - 2025/9/16/medline
PY - 2025/8/14/pubmed
PY - 2025/8/14/entrez
KW - Alternating capture
KW - Left bundle branch area pacing
KW - Left bundle lead placement
KW - Non-selective septal pacing
KW - Paced left bundle effective refractory period
SP - 154089
EP - 154089
JF - Journal of electrocardiology
JO - J Electrocardiol
VL - 92
N2 - Left bundle branch area pacing (LBBAP) is now a common implantation strategy for both pacing and resynchronization based device therapies. While LBBAP has been (somewhat paradoxically) demonstrated to be effective in cases of preexisting left bundle branch (LBB) block, and criteria for LBB capture have been established; minimal focus has been towards the intrinsic refractory rate of the LBB. Herein, we demonstrate a case of LBBAP rate exceeding the refractory period of the LBB, resulting in alternating LBBAP capture and non-selective septal pacing. Implicit understanding of this physiology has important sequel for accurate assessment of lead placement during implantation.
SN - 1532-8430
UR - https://www.unboundmedicine.com/prime/citation/40812288/Paced_electrical_alternans_with_syncope:_Time_for_emergent_pericardiocentesis_
DB - PRIME
DP - Unbound Medicine
ER -
