ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2024
Septal venous channel perforation during left bundle branch area pacing: a prospective study.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Incidence of sinus membrane perforation in transcrestal graftless maxillary sinus augmentation: a meta-analysis.Acta odontologica Scandinavica · 2026Pooled it
- Septal Artery Injury During Left Bundle Branch Area Pacing: Electrophysiological Warning and Coil Embolization.JACC. Case reports · 2026Article
- Computational Modelling of Selective Capture Mechanisms in Conduction System Pacing.Annals of biomedical engineering · 2026Article
- Distinct intracardiac electrogram waveforms with perforation during left bundle branch area pacing implantation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- The importance of contrast fluoroscopy during left bundle branch area pacing: A case report of septal venous channel perforation during implantation.HeartRhythm case reports · 2026Article
- Controversy: in heart failure patients with a reduced ejection fraction and left bundle branch block, conduction system pacing can be a valid alternative to biventricular pacing-pro and contra.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Review
- Need for temporary mechanical circulatory support for dry tamponade caused by interventricular septal hematoma: A case report of a rare complication following left bundle branch area pacing.HeartRhythm case reports · 2025Article
- Complications with Left Bundle Branch Area Pacing: The Flip Side of the Coin.Heart international · 2025Review
- Is conduction system pacing a panacea for pacemaker therapy?Expert review of medical devices · 2024Review
- Stylet-driven Leads or Lumenless Leads for Conduction System Pacing.Arrhythmia & electrophysiology review · 2024Review
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
aimsTo characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP). METHODS AND
resultsAll consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone). An intuitive fluoroscopic schema using orthogonal views (left anterior oblique/right anterior oblique) and familiar landmarks is described. Using this, we resolved zonal distribution (I-VI) of lead position on the ventricular septum and its angulation (post-fixation angle θ). Subjects with and without septal venous channel perforation were compared. Sixty-one patients {male 57.3%, median age [interquartile range (IQR)] 69.5 [62.5-74.5] years} were enrolled. Septal venous channel perforation was observed in eight (13.1%) patients [male 28.5%, median age (IQR) 64 (50-75) years]. They had higher frequency of (i) right-sided implant (25% vs. 1.9%, P = 0.04), (ii) fixation in zone III at the mid-superior septum (75% vs. 28.3%, P = 0.04), (iii) steeper angle of fixation-median θ (IQR) [19 (10-30)° vs. 5 (4-19)°, P = 0.01], and (iv) longer median penetrated-lead length (IQR) [13 (10-14.8) vs. 10 (8.5-12.5) mm, P = 0.03]. Coronary sinus drainage of contrast was noted in five (62.5%) patients. Abnormal impedance drops during implantation (12.5% vs. 5.7%, P = NS) were not significantly different.
conclusionWhen evaluated systematically, septal venous channel perforation may be encountered commonly after LBBAP. The fiducial reference framework described using fluoroscopic imaging identified salient associated findings. This may be addressed with lead repositioning to a more inferior location and is not associated with adverse consequence acutely or in early follow-up.
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