Inadvertent septal perforation during conduction system pacing device implant: a case report.

Background: There has been recent growing interest in the use of conduction system pacing (CSP) for both bradycardia and heart failure indications. There remains a paucity of data, however, regarding complications related to the intraventricular septum associated with CSP implant and the management of these events.
Case Summary: We present a case of a patient with non-ischemic dilated cardiomyopathy presenting for cardiac resynchronization therapy in whom left bundle branch area pacing was complicated with interventricular septal perforation and managed intra-procedurally with repositioning of the lead to provide His bundle pacing (HBP) for QRS correction of underlying left bundle branch block. Post-procedure echocardiography did not show persistent ventricular septal defect. Left ventricular ejection fraction improved from 13% four months before implant to 30% at 32 months post-implant. Corrective HBP pacing thresholds showed a rise at 3-year follow-up.
Discussion: Interventricular septal perforation during CSP is a possible complication during lead fixation. Pre-operative septal assessment with imaging can be helpful to provide important septal anatomical features. Septal perforation can be managed appropriately with lead repositioning intra-procedurally and close follow-up.
Competing Interests: Conflict of interest: J.S. and D.B.S. report no relevant disclosures. R.T. reports speaking or consulting for Abbott, Biotronik, Boston Scientific, and Medtronic. G.A.U. reports speaking or consulting for Abbott, Biotronik, Boston Scientific, GE Healthcare, Medtronic, Philips BioTel, Rhythm Science, and Zoll Medical.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)