Successful termination of ventricular tachycardia by intrinsic antitachycardia pacing delivered from a left bundle branch area pacing lead: a case report.

BACKGROUND: Intrinsic antitachycardia pacing (iATP) is an advanced algorithm designed to optimize pacing sequences for ventricular tachycardia (VT) termination. Although left bundle branch area pacing (LBBAP) has emerged as a physiological pacing strategy and is increasingly incorporated into cardiac resynchronization therapy, its role as a delivery site for iATP remains unclear. CASE SUMMARY: We report a 57-year-old man with advanced heart failure who underwent implantation of LBB-optimized cardiac resynchronization therapy with defibrillator for secondary prevention. During follow-up, multiple episodes of sustained VT with different morphologies were consistently and successfully terminated by iATP delivered exclusively from the LBBAP lead, without the need for conventional ATP or shock therapies. DISCUSSION: This case suggests that conduction system pacing via the LBB area may provide a novel and effective substrate for antitachycardia pacing, potentially enabling more rapid engagement of re-entrant circuits through the His-Purkinje system. Further studies are warranted to establish the efficacy of iATP delivered from conduction system pacing leads.