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Helix breakage during left bundle pacing area implantation.

Amato Santoro1, Simone Taddeucci2

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A pacemaker lead screw fractured during implantation, becoming stuck in the heart's interventricular septum. This complication highlights potential risks during left bundle branch pacing procedures.

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conduction system pacingleft bundle branch pacing area

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Area of Science:

  • Cardiology
  • Medical Device Technology
  • Cardiac Electrophysiology

Background:

  • Left bundle branch pacing (LBBP) is an advanced technique for cardiac pacing.
  • Implantation of LBBP leads involves specific procedural steps and potential complications.
  • Lead positioning and securement are critical for successful pacemaker function.

Purpose of the Study:

  • To report a rare complication during left bundle branch pacing lead implantation.
  • To describe the event of screw incarceration and subsequent rupture.
  • To highlight the importance of careful lead manipulation during pacemaker procedures.

Main Methods:

  • A pacemaker lead was implanted using a stylet driver for left bundle pacing stimulation.
  • Lead positioning was performed, followed by attempted lead retraction.
  • Imaging or surgical visualization was likely used to confirm the complication.

Main Results:

  • Screw incarceration occurred after the initial positioning of the pacemaker lead.
  • The lead screw ruptured during the retraction process.
  • The distal portion of the fractured screw remained lodged within the interventricular septum.

Conclusions:

  • Lead screw rupture is a potential risk during pacemaker implantation, particularly with stylet-driven leads.
  • Interventricular septum incarceration of lead fragments poses a significant clinical challenge.
  • This case underscores the need for meticulous technique and awareness of potential complications in advanced pacing procedures.