Key result
Late LBBAP lead perforation causes VF in a single reported case.
Why the study?
Large clinical studies are needed to establish the indications for conduction system pacing and highlight possible downsides.
Case Report
This case report highlights a severe potential complication of left bundle branch area pacing, specifically late lead perforation leading to ventricular fibrillation.
Raises caution for late LBBAP perforation; hypothesis-generating and requires larger studies before broader adoption.
Conduction system pacing (CSP) is becoming increasingly popular as an alternative to right ventricular (RV) pacing to avoid pacing-induced cardiomyopathy and as an alternative to biventricular pacing to optimize electrical resynchronization of the ventricles. However, large clinical studies are still needed to firmly establish the indications for CSP and to highlight possible downsides. CSP can be achieved either by pacing the His bundle or the left bundle branch area (LBBa). Data suggest that LBBa pacing has several advantages over His bundle pacing, like higher acute success rate, lower thresholds, and more stable pacing values over time.
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Vinther et al. (2024) conducted a case report in Ventricular fibrillation. Left bundle branch area (LBBa) pacing was evaluated. Left bundle branch area pacing lead late perforation caused ventricular fibrillation in a reported case, highlighting the need for large clinical studies to establish indications and downsides.
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