Key result
LBBAP-induced septal perforator ruptures and a giant ~42-mm hematoma cause fatal postoperative circulatory collapse.
Why the study?
Giant interventricular septal hematoma is an extremely rare complication of left bundle branch area pacing, and no fatal cases had been reported previously.
Case Report (n=1)
No
This case report documents the first known fatal outcome of a giant interventricular septal hematoma caused by ruptured septal perforator branches following attempted left bundle branch area pacing in a patient with end-stage heart failure.
Answers are grounded in this paper and cite their sources.
Rare fatal septal hematoma after left bundle branch area pacing in severe systolic dysfunction warrants procedural vigilance; extends known risks to include mortality.
Background Left bundle branch area pacing (LBBAP) is generally safe. Giant interventricular septal hematoma (IVSH) is an extremely rare complication of LBBAP. Previously reported cases had favorable outcomes, and no fatal cases have been reported to date. Case summary A 67-year-old male with 4 years of dilated cardiomyopathy (DCM) and refractory heart failure (HF) had a preoperative left ventricular ejection fraction (LVEF) of 13.2% and left bundle branch block. Following HF stabilization, cardiac resynchronization therapy defibrillator (CRTD) implantation was performed. Intraoperative LBBAP correction was unsatisfactory, and left ventricular lead placement failed. The patient developed chest pain and hypotension 5 h postoperatively. Bedside echocardiography detected a giant IVSH causing biventricular compression and pericardial effusion. Despite emergency extracorporeal membrane oxygenation (ECMO) support, pericardial drainage and interventional embolization, his condition worsened rapidly. Coronary angiography (CAG) identified rupture of multiple septal perforator branches. He succumbed to irreversible circulatory collapse 10 h after surgery. Conclusion Although most patients with LBBAP-associated IVSH achieve a favorable prognosis with timely intervention, the condition can progress rapidly and pose a life-threatening risk in those with end-stage severe HF.
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Li et al. (2026) conducted a case report in Dilated cardiomyopathy, refractory heart failure, and left bundle branch block complicated by giant interventricular septal hematoma (n=1). Left bundle branch area pacing (LBBAP) during CRT-D implantation was evaluated on Fatal giant interventricular septal hematoma (42 mm thickness) and rupture of 6 septal perforator arteries leading to irreversible circulatory collapse. Left bundle branch area pacing complicated by 6 ruptured septal perforators and a 42-mm septal hematoma caused fatal circulatory collapse 10 hours postoperatively in a patient with LVEF 13.2%.
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