Late-onset interventricular septal perforation from left bundle branch pacing

Conduction system pacing has emerged as an alternative to right ventricular (RV) pacing (RVP) in a desire to avoid the adverse hemodynamic effect of RVP on left ventricular (LV) systolic function and associated morbidity and mortality.1 Although His bundle pacing (HBP) has gained prominence, it is limited by a higher capture threshold compared to RVP, reducing battery longevity, and concerns over increasing capture thresholds.2,3 Left bundle branch pacing (LBBP) is a novel method of conduction system pacing that is now being attempted in the quest for physiological pacing with improved stability and better long-term pacing thresholds.