Lead fracture in stylet driven left bundle area pacing following exercise: Coincidence!
Jyotika Gupta1, Pooja Shah2, Anoop K Gupta3
1Ahmedabad University. Gujarat, India.
Indian Pacing and Electrophysiology Journal
|February 27, 2025
Summary
A rare delayed fracture occurred in a stylet-driven lead used for left bundle branch area pacing (LBBAP), causing syncope after exercise. This highlights a potential complication despite the general safety of LBBAP leads.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Left bundle branch area pacing (LBBAP) is an established technique for cardiac pacing.
- Lumenless leads (LLLs) and stylet-driven leads (SDL) are commonly employed for LBBAP procedures.
- Lead fracture is an infrequent complication associated with cardiac pacing leads.
Observation:
- A case of delayed lead fracture in a patient who underwent LBBAP using a stylet-driven lead is presented.
- The lead fracture was identified as the cause of syncope experienced by the patient post-exercise.
Findings:
- The stylet-driven lead, despite being a standard and generally reliable option for LBBAP, exhibited a delayed fracture.
- This fracture event led to significant clinical manifestation, specifically syncope, triggered by physical exertion.
Implications:
- This case underscores the importance of considering lead integrity even with widely used pacing systems.
- Further investigation into the long-term durability and potential failure modes of SDL in LBBAP may be warranted.
- Clinicians should remain vigilant for lead-related complications, particularly in patients experiencing new-onset symptoms after pacing procedures.
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