Late dislodgement of left bundle branch pacing lead and successful extraction

Abstract

A 61-years-old male underwent left bundle branch pacing for nonischemic dilated cardiomyopathy with recurrent heart failure. Left bundle branch pacing (LBBP) resulted in reduction in QRS duration along with improvement in left ventricular ejection fraction (LVEF) to 64% during follow-up. Two years after implantation he had recurrence of symptoms along with decline in LVEF to 51%. Late lead dislodgement was diagnosed and re-do LBBP was planned. The lead was extracted enmasse without complication and a new 3830 lead was positioned deep inside the proximal septum to capture the left bundle. Postprocedure echocardiography showed no ventricular septal defect or damage to tricuspid leaflet.

A rare case of delayed complete lead dislodgement after deep septal pacing: A hidden risk of the specific procedure

“…There has been only one report demonstrating a late partial dislodgement of the lead after DSP. 7 The reasons for the dislodgement might be age, tissue laxity in the pocket, and chest physiotherapy in the previous report. 7 To the best of our knowledge, this is the first report to demonstrate the spontaneous, complete lead dislodgement >2 years after DSP.…”

“…7 The reasons for the dislodgement might be age, tissue laxity in the pocket, and chest physiotherapy in the previous report. 7 To the best of our knowledge, this is the first report to demonstrate the spontaneous, complete lead dislodgement >2 years after DSP. We believe that not only septic bacterial infection but also inadequate adhesion due to the specific lead behavior and lead swinging may be associated with total lead dislodgement.…”

My preferred approach to left bundle branch pacing: Lumenless leads

“…The potential risk for extensive fibrosis around the length of the leads (10–20 mm) inside the interventricular septum and the risks associated with attempted extraction from this location following long dwell times are currently unknown. There are very few reports of lead extraction from the LBBP location, 26 , 27 with the longest duration of 3 years (unpublished personal observation). Surprisingly, the LLLs were easily extracted with simple manual traction in all these cases ( Figure 4 and Video 2 ).…”

Transvenous lead extraction in conduction system pacing

“…With the increased interest in LBP, there have also been questions raised about TLE of these systems, given the deep septal location (see Figure 1 ) and potential for myocardial avulsion and iatrogenic ventricular septal defects. To date, there have been 3 case reports of LBP lead extraction, with all leads being <2 years old ( Vijayaraman, 2020 ; Migliore et al, 2021b ; Ponnusamy and Vijayaraman, 2021 ). In these 3 cases, uncomplicated extraction of these leads was performed by manual traction alone.…”