Why the study?
Deep septal lead deployment during left bundle branch area pacing may occasionally result in unexpected vascular staining.
This case provides the first direct angiographic documentation of unintentional septal arterial entry during LBBAP, emphasizing the utility of contrast injection and demonstrating that prompt lead repositioning leads to safe, benign outcomes.
Unexpected coronary opacification during LBBAP contrast injection warrants procedural vigilance; leaves open optimal depth-assessment techniques.
BACKGROUND: Left bundle branch area pacing (LBBAP) is increasingly adopted as a physiological pacing strategy. Deep septal lead deployment, however, may occasionally result in unexpected vascular staining. CASE SUMMARY: A 70-year-old woman with advanced atrioventricular block and preserved ejection fraction underwent LBBAP. During contrast injection to assess septal lead depth, unexpected opacification of the left anterior descending artery and a septal perforator branch occurred, suggesting inadvertent vascular entry. The lead was promptly repositioned more proximally, achieving optimal electrical parameters. The patient remained asymptomatic, and follow-up echocardiography confirmed preserved ventricular function without pericardial effusion or hematoma. DISCUSSION: To our knowledge, this is the first report providing direct angiographic visualization of coronary opacification during LBBAP, highlighting the importance of septal vascular anatomy and imaging guidance. TAKE-HOME MESSAGES: Inadvertent vascular staining during LBBAP is rare and usually benign when promptly recognized. Angiographic contrast injection is useful to confirm lead position and detect unintended vascular entry.
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Costantino et al. (2025) studied this question.
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