Surgical management of left bundle branch pacing lead causing septal and left ventricular perforation

Key Teaching Points•Right ventricular lead perforation of the interventricular septum and left ventricular free wall after left bundle branch pacing wire placement can be a life-threatening event that requires prompt intervention.•The clinical presentation of right ventricular septal lead perforation can vary depending on the lead tip location, lead type, extent of perforation, injury to the right or left ventricular free walls, and injury to surrounding anatomic structures.•As the prevalence of implantable cardiac pacemaker devices increases and new biventricular pacing techniques requiring lead fixation to the interventricular septum grow, multidisciplinary teams of cardiac surgeons, cardiologists, and emergency room physicians need to promptly recognize and deal with the sequelae and complications of these technologies. •Right ventricular lead perforation of the interventricular septum and left ventricular free wall after left bundle branch pacing wire placement can be a life-threatening event that requires prompt intervention.•The clinical presentation of right ventricular septal lead perforation can vary depending on the lead tip location, lead type, extent of perforation, injury to the right or left ventricular free walls, and injury to surrounding anatomic structures.•As the prevalence of implantable cardiac pacemaker devices increases and new biventricular pacing techniques requiring lead fixation to the interventricular septum grow, multidisciplinary teams of cardiac surgeons, cardiologists, and emergency room physicians need to promptly recognize and deal with the sequelae and complications of these technologies.