Left Bundle Branch Area Pacing Lead Perforation Complicated by Left Ventricular Thrombus

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Imaging

Background:

• Left bundle branch area pacing (LBBAP) is an advanced pacing technique.
• Lead perforation is a rare but serious complication of cardiac implantable electronic devices.
• Septal perforation can lead to cardiac chamber or wall injury.

Purpose of the Study:

• To report a case of intracardiac mass formation secondary to septal lead perforation during LBBAP.
• To highlight the diagnostic utility of echocardiography in identifying lead-related complications.
• To emphasize the role of anticoagulation in managing cardiac thrombus.

Main Methods:

• A 72-year-old female patient underwent LBBAP.
• Transthoracic echocardiography (TTE) initially suggested septal lead perforation.
• Transesophageal echocardiography (TEE) was performed for detailed anatomical assessment.

Main Results:

• TEE identified an intracardiac mass.
• The mass demonstrated resolution following anticoagulation therapy.
• The findings suggest the mass was a left ventricular thrombus.

Conclusions:

• Septal lead perforation during LBBAP can result in left ventricular thrombus formation.
• Echocardiography, particularly TEE, is crucial for diagnosing such complications.
• Anticoagulation is an effective treatment for resolving device-related cardiac thrombi.