Key result
LBBAP implantation can cause septal venous channel perforation, highlighting the need for contrast fluoroscopy.
Why the study?
Left bundle branch area pacing (LBBAP) is a promising pacing technique with advantages over traditional right ventricular pacing, but procedural complications such as septal venous channel perforation require attention.
Case Report (n=1)
This case report highlights the importance of using contrast fluoroscopy to identify and manage septal venous channel perforation during left bundle branch area pacing.
LBBAP may be feasible in select cases; leaves open whether it reduces desynchrony versus RV pacing in broader populations.
Cardiac pacing remains a cornerstone in managing bradyarrhythmia and heart failure with reduced ejection fraction.1 Although traditional right ventricular apical pacing is effective, its nonphysiological activation pattern can lead to desynchrony and adverse outcomes such as atrial arrhythmias and pacing-induced cardiomyopathy.2 Left bundle branch area pacing (LBBAP) has recently emerged as a promising adjunct, offering electrical parameters comparable with bradycardia pacing, resynchronization with comparatively short procedural times with cardiac resynchronization therapy, and lower capture thresholds than His bundle pacing.
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Zhou et al. (2025) conducted a case report in Bradyarrhythmia and heart failure with reduced ejection fraction (n=1). Left bundle branch area pacing (LBBAP) with contrast fluoroscopy was evaluated. Left bundle branch area pacing implantation can result in septal venous channel perforation, highlighting the importance of contrast fluoroscopy during the procedure.
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