Recurrent Cardiac Tamponade as a Complication of Prolonged Left Bundle Branch Area Pacing

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Post-cardiac injury syndrome (PCIS) is a known complication following cardiac interventions.
• It is often linked to an immune response, particularly after pacemaker lead implantation.
• PCIS can manifest as pericardial effusion, potentially leading to cardiac tamponade.

Purpose of the Study:

• To report a case of PCIS presenting with recurrent cardiac tamponade.
• To highlight potential risks associated with novel pacing techniques like left bundle branch area pacing (LBBAP).
• To underscore the association between prolonged procedures and PCIS development.

Main Methods:

• Case report detailing a patient who underwent LBBAP implantation.
• Description of the patient's challenging anatomy and prolonged procedural time.
• Observation of the patient's presentation with recurrent cardiac tamponade.

Main Results:

• The patient developed PCIS with recurrent cardiac tamponade after a prolonged LBBAP procedure.
• Difficult anatomy contributed to the extended procedural duration.
• The case illustrates a potential complication of LBBAP in complex cases.

Conclusions:

• Prolonged fluoroscopy during cardiac procedures may increase the risk of PCIS.
• Active pacemaker lead fixation is identified as a risk factor for PCIS due to immune reactions.
• LBBAP in adults with congenital heart disease presents unique challenges due to anatomical variations.