Left bundle branch area pacing successfully managed irreversible LV lead electrical failure in a 67-year-old man, improving his LV ejection fraction from 10-15% to 20-25% at 1-month follow-up.
Case Report (n=1)
Left bundle branch area pacing serves as a practical physiological alternative for cardiac resynchronization when coronary sinus lead re-implantation is not feasible due to irreversible electrical failure.
Abstract Background Conductor externalisation is a recognised mechanism of transvenous lead failure. In left-ventricular (LV) coronary-sinus (CS) leads, irreversible electrical failure requiring extraction is uncommon. Conduction system pacing (CSP) with left bundle branch area pacing (LBBAP) can provide a physiological alternative when CS re-implantation is not feasible. Case summary A 67-year-old man with non-ischaemic cardiomyopathy (NICM) and reduced LV ejection fraction (EF) secondary to infective endocarditis (IE) with severe aortic/mitral regurgitation underwent bioprosthetic aortic valve replacement with mitral repair and cardiac resynchronisation therapy-defibrillator (CRT-D) implantation in 2021 after drug-associated torsade de pointes and ventricular fibrillation (VF) arrest. He underwent transcatheter edge-to-edge mitral repair in June 2024. At routine review in October 2024, he was clinically well and asymptomatic; LV lead testing showed very high impedance (3000 Ω), threshold 5.75 V at 1.0 ms, and intermittent loss of capture. Chest radiography showed stable lead position. At revision in March 2025, the extracted LV lead displayed conductor externalisation, and CS re-implantation was precluded by a small, unwireable anterolateral branch. LBBAP was implanted with low capture threshold and stable sensing; the generator was replaced without complications. At 1-month follow-up, the LV EF was 20–25% (previously 10–15% in 2024); by August 2025 he was New York Heart Association (NYHA) class I and euvolaemic with stable weight. Conclusion This case demonstrates persistent electrical failure in LV CS lead with extraction-confirmed conductor externalisation, contrasts with prior reports of electrically silent or transient disturbance, and supports LBBAP as a practical physiological option when CS re-implantation is not feasible.
Almohammad et al. (Thu,) conducted a case report in Left-ventricular lead electrical failure from conductor externalisation (n=1). Left bundle branch area pacing (LBBAP) was evaluated. Left bundle branch area pacing successfully managed irreversible LV lead electrical failure in a 67-year-old man, improving his LV ejection fraction from 10-15% to 20-25% at 1-month follow-up.