Left Bundle Branch Pacing in a Scoliosis Patient with Symptomatic Bradyarrhythmia: A Case Report

Right ventricle (RV) has been the preferred site for pacing in symptomatic brady-arrhythmia. It has also been one of the sites of pacing in cardiac resynchronization therapy. However various studies have demonstrated the deleterious effects of chronic RV pacing. To ameliorate these effects, novel pacing strategy called the physiological pacing has come up where His bundle or Left bundle branch area is paced directly with pacing leads. This method, however, requires precise localization of His bundle, left bundle branch area in interventricular septum and also the normally oriented heart shadow on imaging. Herewith, we are reporting a case of left bundle branch pacing in scoliosis patient with altered radiographic landmarks. The simple maneuvers described here may be useful in reaching the desired pacing site in such cases.