Interventricular Septal Hematoma Complicating Left Branch Bundle Lead Implantation: Treatment by Covered Stent

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Cardiac resynchronization therapy (CRT) is a treatment for heart failure with reduced ejection fraction.
• Left bundle branch pacing (LBBP) is an advanced CRT technique.
• Complications during lead implantation can occur, requiring prompt management.

Observation:

• A patient undergoing LBBP experienced a rare complication: perforation of a septal branch artery.
• This perforation led to the formation of an iatrogenic coronary fistula.
• The fistula resulted in a significant septal hematoma and hemodynamic compromise, presenting as shock.

Findings:

• The diagnostic workup confirmed an iatrogenic coronary fistula and associated septal hematoma.
• The patient's condition rapidly deteriorated, leading to cardiogenic shock.
• Endovascular management using covered stents was employed to occlude the fistula.

Implications:

• This case highlights a rare but serious complication of LBBP lead implantation.
• Successful management with covered stents demonstrates the efficacy of endovascular techniques for iatrogenic coronary fistulas.
• Awareness of this complication is crucial for electrophysiologists performing LBBP.