In patients with persistent left superior vena cava (PLSVC), transvenous device implantation for cardiac resynchronization therapy (CRT) may be challenging. We present a complex case with successful, high‐density electroanatomic mapping (EAM) guided corrective His bundle pacing (CHBP) following failed CRT upgrade in a patient with PLSVC, congenital heart disease, and pacing‐associated heart failure. CHBP restored physiological conduction in left bundle branch block with complete conduction block leading to clinical improvement and cardiac remodeling. The presented case supports the growing evidence that EAM‐guided CHBP may be considered a feasible alternative to conventional CRT when venous anatomy is not favorable for left ventricular lead implantation.

中文翻译：

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持续左上腔静脉 CRT 升级失败后高密度标测引导的矫正 HIS 束起搏。

对于持续性左上腔静脉 (PLSVC) 患者，经静脉装置植入进行心脏再同步治疗 (CRT) 可能具有挑战性。我们介绍了一个复杂的案例，该案例在 PLSVC、先天性心脏病和起搏相关心力衰竭患者的 CRT 升级失败后，成功进行了高密度电解剖图 (EAM) 引导的矫正希氏束起搏 (CHBP)。CHBP 恢复左束支传导阻滞的生理传导，完全传导阻滞导致临床改善和心脏重塑。所呈现的案例支持越来越多的证据，即当静脉解剖不利于左心室导线植入时，EAM 引导的 CHBP 可被视为传统 CRT 的可行替代方案。