Key result
Delayed LBBAP lead protrusion into the LV can present post-discharge as unipolar loss of capture.
Why the study?
Delayed lead perforation into the LV cavity after LBBAP is less common than acute perforation and may be associated with severe adverse events.
Initial unipolar pacing programming after left bundle branch area pacing may facilitate early detection of delayed lead perforation by revealing loss of capture.
Initial unipolar pacing post-LBBAP may aid early detection of delayed perforation; hypothesis-generating, needing prospective trials before adoption.
Delayed lead perforation into the left ventricular (LV) cavity after left bundle branch area pacing (LBBAP) is less common than in the acute setting and could be associated with severe adverse events. We present the case of a young patient with symptomatic second-degree atrioventricular block who developed partial protrusion of the LBBAP lead into the LV cavity after discharge. While adequate conduction system capture was still seen with bipolar pacing, this potentially serious complication was self-diagnosed by the patient due to the initial ventricular pacing programming in a unipolar setting, which revealed the complete loss of capture.
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Pestrea et al. (2026) studied this question. Delayed partial protrusion of the LBBAP lead into the LV cavity can occur post-discharge and was self-diagnosed by the patient due to initial unipolar ventricular pacing showing loss of capture.
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