Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Complete atrioventricular block with LBBAP lead-related complication (n=1). Intervention: Sheath-assisted access-preserving technique. Primary outcome: Successful LBBAP lead reimplantation without additional venous puncture.

Q: What does this research mean for the field?

A sheath-assisted access-preserving technique allows successful left bundle branch area pacing lead revision without requiring additional venous puncture. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yuki Hiruma; Noriaki Moriyama; Hikaru Tanemura; Kunihiko Shimizu; Masato Murakami; Shigeru Saito

doi:10.1016/j.jaccas.2026.109785

August 1, 2026JACC Case ReportsOpen Access

Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture

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Key result

Sheath-assisted access-preserving technique allows LBBAP lead revision without new venous puncture after delayed septal perforation.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY 4.0

Why the study?

Redo procedures for lead-related complications after left bundle branch area pacing may require additional venous puncture to regain access.

Key Points

To describe an access-preserving, sheath-assisted technique for lead revision following delayed septal perforation in left bundle branch area pacing without requiring an additional venous puncture.
Evaluated a 79-year-old man who experienced pacing threshold elevation and loss of capture 4 days after left bundle branch area pacing for complete atrioventricular block.
Advanced a modified 4-F short sheath over the displaced lead under fluoroscopy to insert a guidewire, upsize the sheath, and reimplant the pacing lead using the original venous access.
Fluoroscopic imaging confirmed complete interventricular septal perforation with the pacing lead tip migrating into the left ventricular cavity.
Lead reimplantation was successfully executed using standard delivery sheaths and guidewires over the existing tract without requiring a second venous puncture.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 79-year-old man with complete atrioventricular block who required LBBAP lead revision 4 days post-implantation due to delayed septal perforation.

I

Intervention

Sheath-assisted access-preserving technique using a modified 4-F short sheath advanced over the existing lead for LBBAP lead revision.

O

Outcome

Successful LBBAP lead reimplantation without additional venous puncture.

Implication

A sheath-assisted access-preserving technique can facilitate LBBAP lead revision without the need for additional venous puncture in cases of delayed septal perforation.

Abstract

BACKGROUND: Left bundle branch area pacing (LBBAP) requires delivery-sheath support for implantation and revision. Redo procedures for lead-related complications may require additional venous puncture to regain access. CASE SUMMARY: A 79-year-old man underwent LBBAP for complete atrioventricular block. Four days later, abrupt threshold elevation and loss of capture occurred. Fluoroscopy showed complete interventricular septal perforation with lead-tip migration into the left ventricular cavity. Lead revision was performed using a sheath-assisted access-preserving technique without additional venous puncture. A modified 4-F short sheath was advanced over the existing lead, allowing guidewire insertion, sheath upsizing, and successful LBBAP lead reimplantation. DISCUSSION: Delayed septal perforation is a rare but recognized LBBAP complication. This case demonstrates a simple technique using standard sheaths and guidewires that may reduce invasiveness during selected redo LBBAP procedures. TAKE-HOME MESSAGE: Sheath-assisted access preservation can facilitate LBBAP lead revision without additional venous puncture.

Discussion

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Cite This Study

Hiruma et al. (2026) conducted a case report in Complete atrioventricular block with LBBAP lead-related complication (n=1). Sheath-assisted access-preserving technique was evaluated on Successful LBBAP lead reimplantation without additional venous puncture. A sheath-assisted access-preserving technique allowed successful LBBAP lead revision without additional venous puncture in a patient with delayed septal perforation.

synapsesocial.com/papers/6a8343cb65d10cbb45d9cb92 https://doi.org/10.1016/j.jaccas.2026.109785

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Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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