Severe Acute Coronary Syndrome After Left Bundle Branch Area Pacing
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND: Left bundle branch area pacing (LBBAP) is a physiologic pacing technique increasingly used for bradyarrhythmia and heart failure indications. Rare complications include interventricular septal hematoma (IVSH), which may compress collateral flow and present as acute myocardial infarction. CASE SUMMARY: A 79-year-old woman with chronic total occlusion of the left anterior descending artery and prior stenting of the right coronary artery underwent dual-chamber pacemaker implantation with LBBAP. Twelve hours later, she developed chest pain, pulmonary edema, new anterior ST-segment elevation, and a drop in left ventricular ejection fraction from 54% to 33%. Echocardiography revealed a septal hematoma (14 × 24 mm) surrounding the pacing lead. DISCUSSION: A multidisciplinary team including electrophysiology, interventional cardiology, heart failure, and cardiac surgery considered lead revision, percutaneous coronary intervention, coronary artery bypass grafting, and conservative care. Given stable pacing parameters, collateral-dependent chronic total occlusion of the left anterior descending artery, and regression of hematoma on surveillance, conservative management was chosen with staged antithrombotic reintroduction and surgical standby. CONCLUSIONS: IVSH can precipitate Killip class III ST-segment elevation myocardial infarction after LBBAP without new coronary occlusion. Multidisciplinary team-guided conservative therapy with close surveillance can be safe in selected cases.
Source: JACC Case Reports
Authors: Ngoc Dung Kieu, Quoc-Hoang Nguyen, Thai Duy Vo, Le Son Nguyen Khac, Le Uyen Phuong Tran, Tri Thuc Nguyen
Institutions: Cho Ray Hospital, Ministry of Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $850
OpenAlex ID: W4416965322