{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:06:13Z","timestamp":1768871173697,"version":"3.49.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Markus Sikkel\u2019s research"},{"DOI":"10.13039\/501100023238","name":"Victoria Hospitals Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023238","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Island Health Catalyst"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac resynchronization therapy (CRT) is a well-established treatment with heart failure (HF) and conduction delays. Complex anatomy, such as coronary sinus (CS) stenosis can render LV lead placement challenging or impossible. Alternate strategies such as epicardial and left bundle branch area pacing (LBBAP) exist, though have their own disadvantages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 72-year-old male with a history of ischaemic cardiomyopathy, LV dysfunction, and pacemaker dependence presented to hospital in decompensated HF after two failed attempts to upgrade to a CRT system, the latest including a sub-optimal LBBAP lead. The patient was brought back to the EP lab for a third attempt to engage the CS. Despite several different techniques, these attempts failed. With the patients consent, we proceeded to an off-label bailout strategy by placing an LV endocardial lead using LBBAP tools. When combined with pacing simultaneously through the previously positioned LBBAP, lead this gave an improved QRS morphology on the surface ECG. In follow-up, the patient\u2019s functional class and left ventricular ejection fraction improved, while maintaining 98.3% biventricular pacing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>We present a complex patient who ultimately benefited from the novel use of LBBAP equipment to place an endocardial LV lead via the interventricular septum in the setting of several prior failed attempts at placing a traditional LV lead through a stenosed CS. No further options remained for this patient, with palliation as the only alternative. Endocardial LV lead placement should be studied as in future trials as an alternative to traditional transvenous and epicardial CRT systems prior to widespread adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf287","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T08:00:44Z","timestamp":1750406444000},"source":"Crossref","is-referenced-by-count":0,"title":["A case report: SPEAR-CRT: first description of use of left bundle branch area pacing tools and techniques to place an endocardial LV lead via the interventricular septum in a patient with ostial coronary sinus occlusion"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5719-2997","authenticated-orcid":false,"given":"Jason A","family":"Gencher","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Electrophysiology, Montreal Heart Institute , 5000 Rue Belanger, Montreal, QC, Canada H1T 1C8"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Yao","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of British Columbia , 9th Floor, 2775 Laurel Street, Vancouver, BC, Canda V5Z 1M9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Van Zyl","sequence":"additional","affiliation":[{"name":"Division of Medical Sciences, University of Victoria , 3800 Finnerty Road, Victoria, BC, Canada V8P 5C2"},{"name":"Division of Cardiology, Royal Jubilee Hospital, Coronation Annex , 1952 Bay Street, Victoria, BC, Canada V8R 1J8"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Thibert","sequence":"additional","affiliation":[{"name":"Division of Medical Sciences, University of Victoria , 3800 Finnerty Road, Victoria, BC, Canada V8P 5C2"},{"name":"Division of Cardiology, Royal Jubilee Hospital, Coronation Annex , 1952 Bay Street, Victoria, BC, Canada V8R 1J8"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus B","family":"Sikkel","sequence":"additional","affiliation":[{"name":"Division of Medical Sciences, University of Victoria , 3800 Finnerty Road, Victoria, BC, Canada V8P 5C2"},{"name":"Division of Cardiology, Royal Jubilee Hospital, Coronation Annex , 1952 Bay Street, Victoria, BC, Canada V8R 1J8"},{"name":"Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia , 9th Floor, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"2026011907164115500_ytaf287-B1","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMoa050496","article-title":"The effect of cardiac resynchronization on morbidity and mortality in heart failure","volume":"352","author":"Cleland","year":"2005","journal-title":"N Engl J Med"},{"key":"2026011907164115500_ytaf287-B2","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1056\/NEJMoa1210356","article-title":"Biventricular pacing for atrioventricular block and systolic dysfunction","volume":"368","author":"Curtis","year":"2013","journal-title":"N Engl J Med"},{"key":"2026011907164115500_ytaf287-B3","author":"Chelu"},{"key":"2026011907164115500_ytaf287-B4","author":"Joza"},{"key":"2026011907164115500_ytaf287-B5","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1001\/jama.289.6.730","article-title":"Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials","volume":"289","author":"Bradley","year":"2003","journal-title":"JAMA"},{"key":"2026011907164115500_ytaf287-B6","doi-asserted-by":"crossref","first-page":"e013059","DOI":"10.1161\/CIRCEP.124.013059","article-title":"Multicenter hemodynamic assessment of the LOT-CRT strategy: when does combining left bundle branch pacing and coronary venous pacing enhance resynchronization? Primary results of the CSPOT study","volume":"17","author":"Jastrz\u0119bski","year":"2024","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026011907164115500_ytaf287-B7","first-page":"e382","article-title":"2018 ACC\/AHA\/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines and the heart rhythm society","volume":"140","author":"Kusumoto","year":"2019","journal-title":"Circulation"},{"key":"2026011907164115500_ytaf287-B8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.hrthm.2021.07.057","article-title":"Left bundle branch\u2013optimized cardiac resynchronization therapy (LOT-CRT): results from an international LBBAP collaborative study group","volume":"19","author":"Jastrz\u0119bski","year":"2022","journal-title":"Heart Rhythm"},{"key":"2026011907164115500_ytaf287-B9","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.hrthm.2014.11.004","article-title":"Epicardial leads in adult cardiac resynchronization therapy recipients: a study on lead performance, durability, and safety","volume":"12","author":"Buiten","year":"2015","journal-title":"Heart rhythm"},{"key":"2026011907164115500_ytaf287-B10","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.hrthm.2006.11.023","article-title":"Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy","volume":"4","author":"van Gelder","year":"2007","journal-title":"Heart rhythm"},{"key":"2026011907164115500_ytaf287-B11","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: developed by the task force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) with the special contribution of the European heart rhythm association (EHRA)","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2026011907164115500_ytaf287-B12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/europace\/euw381","article-title":"Endocardial left ventricular pacing for cardiac resynchronization: systematic review and meta-analysis","volume":"20","author":"Gamble","year":"2018","journal-title":"EP Europace"},{"key":"2026011907164115500_ytaf287-B13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1161\/CIRCEP.113.001110","article-title":"Development of a technique for left ventricular endocardial pacing via puncture of the interventricular septum","volume":"7","author":"Betts","year":"2014","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026011907164115500_ytaf287-B14","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/pace.12125","article-title":"Direct left ventricular endocardial pacing: an alternative when traditional resynchronization via coronary Sinus is not feasible or effective","volume":"36","author":"Mori\u00d1A-V\u00c1Zquez","year":"2013","journal-title":"Pacing Clin Electrophysiol"},{"key":"2026011907164115500_ytaf287-B15","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/j.1540-8159.2011.03138.x","article-title":"Transseptal left ventricular endocardial pacing reduces dispersion of ventricular repolarization","volume":"34","author":"Scott","year":"2011","journal-title":"Pacing Clin Electrophysiol"}],"container-title":["European Heart Journal - 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