ArticleJACC. Case reports2025
Severe Acute Coronary Syndrome After Left Bundle Branch Area Pacing: Multidisciplinary Team-Guided Management of Intraseptal Hematoma.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeft 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.
conclusionsIVSH 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.
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