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Updated: Sep 20, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Septal coronary artery fistula after left bundle branch area pacing assessed by multi-imaging modalities and shunt
Hiroyuki Kato1, Satoshi Yanagisawa2, Ryusuke Ota1
1Division of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan.
Abstract:
Septal coronary artery fistula is a rare but concerning complication of left bundle branch area pacing (LBBAP). We report the case of an 82-year-old man who was indicated for cardiac resynchronization therapy and underwent LBBAP. The patient had no chest symptoms during or after implantation. Postoperative echocardiography demonstrated a new abnormal tunnel inside the interventricular septum (IVS) and shunt flow from the IVS toward the right ventricle. Coronary angiography confirmed a septal coronary artery fistula, which might have been formed by failed deep screw attempts. Since the shunt volume assessed by the Qp /Qs was small, the patient was treated conservatively.
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