Lead-to-lead interaction leading to left bundle branch area pacing lead failure

Figure 1. Impedance and threshold trend. A: Impedance and threshold rise in 3830 SelectSecure lead (Medtronic Inc, Minneapolis, MN), followed by open circuit and loss of capture. B: Fluoroscopic image demonstrating the defibrillator lead coil in contact with the proximal end of the ring electrode of 3830 SelectSecure lead. A sharp bend in the 3830 SelectSecure lead is seen where the defibrillator lead coil appears to make contact.

Figure 2. Macroscopic image of the lead fracture. A: Apparent visible wear and tear on the 3830 SelectSecure lead (Medtronic Inc, Minneapolis, MN) after explanation. B: Wear through the outer insulation, outer coil, ethylene-tetrafluoroethylene on the tip conductor, and the tip conductor. C: Longitudinal and 3-dimensional schematic of the 3830 SelectSecure lead. (Images used with permission from Medtronic, plc © 2022.)

Figure 3. Chest radiography and electrocardiogram of initial and final lead position. A: Chest radiograph showing the posterior location of the left bundle branch area pacing (LBBAP) lead after initial implantation with proximity of the ring electrode to the defibrillator lead coil. B: Chest radiograph showing a more anterior location of the LBBAP lead after reimplantation with adequate distance from the defibrillator lead. C: Pacing morphology of initial implant with anodal capture and nonselective left septal capture. D: Pacing morphology of new implant with anodal capture and nonselective left bundle selective capture.