Work

Unintentional Septal Arterial Entry During Left Bundle Branch Area Pacing

Year: 2025

Type: article

Abstract: 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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106283

Authors: Jacopo Costantino, Barbara Romani, Lorenzo Maria Zuccaro, Massimiliano Campoli, Daniele Porcelli

Institutions: University of Padua, Ospedale San Pietro Fatebenefratelli, Sapienza University of Rome

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850