Key result
Left bundle branch area pacing in a 58-year-old man resulted in septal branch perforation and interventricular septal hematoma, successfully managed with transcatheter coil embolization.
Why the study?
Left bundle branch area pacing requires deep septal lead implantation and carries a risk of septal vascular injury.
Case Report (n=1)
Abnormal pacing parameters and ventricular arrhythmias during LBBAP may indicate septal vascular injury, a rare but serious complication requiring prompt recognition and intervention.
LBBAP lead repositioning may cause acute septal injury; leaves open the need for refined techniques and prospective safety data.
BACKGROUND: Left bundle branch area pacing (LBBAP) requires deep septal lead implantation and carries a risk of septal vascular injury. CASE SUMMARY: A 58-year-old man with binodal disease underwent dual-chamber pacemaker implantation using LBBAP. Initial high septal lead placement was associated with markedly elevated impedance and suboptimal pacing parameters. After repositioning, parameters normalized. However, the patient developed acute chest pain, ST-segment elevation, and ventricular tachycardia. Coronary angiography demonstrated septal branch perforation with contrast extravasation, and echocardiography confirmed an interventricular septal hematoma. Transcatheter coil embolization achieved complete hemostasis with favorable recovery. DISCUSSION: Abnormal pacing parameters and ventricular arrhythmias may represent early electrophysiological markers of septal vascular injury during LBBAP, providing important insights into its recognition, management, and procedural implications. TAKE-HOME MESSAGES: Septal branch injury is a rare but potentially serious complication of LBBAP. Early recognition and prompt imaging-guided intervention are essential to ensure procedural safety.
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Song et al. (2026) conducted a case report in Binodal disease (n=1). Left bundle branch area pacing (LBBAP) was evaluated on Septal vascular injury. Left bundle branch area pacing in a 58-year-old man resulted in septal branch perforation and interventricular septal hematoma, successfully managed with transcatheter coil embolization.