Unipolar diathermy applied via the terminal pin to release an entrapped LBBAP lead helix: a case report

Left bundle branch area pacing (LBBAP) is increasingly being adopted as a physiological solution to both bradycardia and resynchronization indications. Deep septal positioning of both stylet-less and stylet driven leads can be complicated by unexpected entrapment in myocardial or fibrotic tissue, making advancement or removal of the lead challenging.

A patient undergoing LBBAP implantation demonstrated suboptimal electrical parameters after initial lead advancement. Both helical retraction and counter clockwise rotation was unsuccessful in displacing the lead for a second attempt. In line with the only other case study in this situation, 3S of 40W unipolar diathermy was applied to the terminal pin, allowing electrical current to dissipate through the lead tip-tissue interface. This resulted in immediate release of the helix and successful extraction of the lead without mechanical or clinical complications.

Entrapment of the helix during LBBAP is a recognized procedural challenge but inability to overcome this with mechanical disengagement techniques is rare. This occurrence is more likely with extendable helix leads. This case demonstrates a challenging scenario whereby the helix could not be successfully retracted and the lead removed. The novel rescue technique was adapted from a previous case and reinforces the feasibility of this technique.