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EP News: Case Reports

  • T. Jared Bunch
    Correspondence
    Address reprint requests and correspondence: Dr T. Jared Bunch, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132.
    Affiliations
    Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Published:November 04, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.028
      Physiologic pacing from either His bundle pacing or left bundle branch area pacing (LBBAP) can minimize electrical and mechanical dyssynchrony associated with typical right ventricular septal pacing. LBBAP is relatively new compared with other forms of pacing, and the potential long-term risks and benefits are still be elucidated. Mahajan et al (https://doi.org/10.1016/j.hrcr.2022.10.007) shared a case of a 68-year-old man with atrial fibrillation and nonischemic cardiomyopathy (25%–30%) who underwent atrioventricular node ablation and implantable cardioverter-defibrillator insertion with a 3830 SelectSecure lead (Medtronic, Minneapolis, MN) implanted for LBBAP. LBBAP lead demonstrated a capture threshold at 3 V and nonselective left bundle capture at 0.5 V at 0.4 ms. Twenty months after the implant, an acute rise in impedance was observed with loss of capture of the LBBAP lead. Fluoroscopy revealed lead to lead interaction with the implantable cardioverter-defibrillator (ICD) and LBBAP leads and a sharp bend in the LBBAP lead as it engaged the septum. The LBBAP lead was removed with manual traction and a new LBBAP placed with care not to interact with the ICD lead. Gross inspection of the extracted lead showed a break in insulation and conductor where the lead was in contact with the defibrillator coil. This is the first report of 3830 SelectSecure lead failure related to lead to lead interaction and raises awareness about this possibility in LBBAP, where lead interactions can be common and forces unique related to the deep septal insertion.
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