Left Bundle Branch Area Pacing in a Patient with Ebstein’s Anomaly from a Functional Right Atrium Using the Sheath-in-sheath Technique

Key Teaching Points•Left bundle branch area pacing (LBBAP) for Ebstein’s anomaly is possible with deep lead fixation from a functional right atrium.•Using a 9F coronary sinus left ventricular lead delivery sheath and a C315 His delivery catheter as a sheath-in-sheath technique can be safe and effective in LBBAP.•The sheath-in-sheath technique is useful to provide adequate backup for deep lead fixation even if the lead has reached the fixation site. •Left bundle branch area pacing (LBBAP) for Ebstein’s anomaly is possible with deep lead fixation from a functional right atrium.•Using a 9F coronary sinus left ventricular lead delivery sheath and a C315 His delivery catheter as a sheath-in-sheath technique can be safe and effective in LBBAP.•The sheath-in-sheath technique is useful to provide adequate backup for deep lead fixation even if the lead has reached the fixation site.