Septal venous channel perforation during left bundle branch area pacing: a prospective study

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Left bundle branch area pacing (LBBAP) is an advanced His-bundle pacing technique.
• Understanding potential complications like septal venous channel perforation is crucial for procedural safety and efficacy.

Purpose of the Study:

• To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during LBBAP.
• To describe a fluoroscopic imaging schema for identifying lead position and perforation.

Main Methods:

• Prospective study of 61 consecutive patients undergoing LBBAP over 8 months.
• Obligatory septal contrast injection at lead entry and fixation zones.
• Fluoroscopic imaging with orthogonal views to assess lead position (zones I-VI) and fixation angle (θ).

Main Results:

• Septal venous channel perforation occurred in 13.1% of patients.
• Perforation was associated with right-sided implantation, mid-superior septal fixation (zone III), steeper fixation angles, and longer penetrated lead length.
• Contrast drainage into the coronary sinus was observed in 62.5% of perforated cases.

Conclusions:

• Septal venous channel perforation is a common finding during LBBAP when systematically evaluated.
• A described fluoroscopic framework aids in identifying associated findings.
• Lead repositioning to an inferior location is a viable management strategy with no acute adverse consequences.