Abstract
This case series describes three heart failure patients with right atrial conduction disturbances, where lead placement in the lower atrium was used to optimize intra-atrial conduction. By shortening conduction delays, improving intrinsic conduction, and reducing the atrioventricular interval, this approach enabled successful left ventricular-only pacing. This strategy proved particularly beneficial for patients with prolonged intra-atrial conduction. In all cases, the intervention led to significant improvements in heart failure symptoms. These findings suggest that lower atrial lead placement may enhance the performance of cardiac implantable electronic devices and improve clinical outcomes in patients with complex conduction disorders. LEARNING OBJECTIVE: This case series highlights lower atrial septal lead placement as an effective strategy for optimizing cardiac device function in patients with intra-atrial conduction disturbances. The pacing technique shortens conduction delays, improves intrinsic conduction, and reduces the atrioventricular interval, facilitating left ventricular-only pacing. This approach is particularly beneficial for patients with prolonged intra-atrial conduction, potentially improving heart failure management and patient outcomes in complex conduction disorders.