Lead-to-lead interaction leading to left bundle branch area pacing lead failure

Interaction between left bundle branch area pacing lead and defibrillator lead: A case report

“…A recent publication already reports on catastrophic complication following LBBAP and ICD lead interaction. 8 In contrast to our case, no EGMs alerted the physician of the possible contact between the 2 leads, and lead fracture was the first clinical manifestation of the interaction. In our case, intraoperative tests of the LBBAP lead were performed using a unipolar configuration where the implanter is blind to EGMs using the ring electrode.…”

“…Several publications report on inappropriate sensing and inhibition, inappropriate ICD therapies, noise, insulation breach, and even lead rupture following the repetitive contact between pacing and/or defibrillation leads. 8 , 9 With the development of conduction system pacing (CSP), cardiac resynchronization can be achieved with only 1 lead instead of 2 leads, as for conventional biventricular pacing. One would therefore expect a lower risk of lead interaction.…”

Mechanisms of damage related to ICD and pacemaker lead interaction

“…Complete fracture and substantial damage to the pacing lead was observed after 40 million cycles (n = 4 of 6), with accompanying damage initiated to the ICD defibrillation electrode coils. The damage to the pacing lead was similar to the findings of Mahajan et al 2 ( Figure 1 , bottom right; Online Supplemental Figure 3 ).…”

“…The interaction between 2 leads is one of the few mechanisms that may cause damage to both insulation and conductors and could ultimately cause loss of therapy. 1 , 2 The general guidance is to avoid contact between leads, which can be challenging. However, there is limited information about the time progression of damage and factors that may influence which lead is damaged.…”

“…Testing was motivated by the observations of a case where the pacing lead was observed to have substantial damage after interacting with the defibrillation lead for 21 months, or approximately 55 million heartbeats. 2 The pacing lead in that case was returned to the manufacturer for analysis and wear scar characterization, providing a basis for comparison with in vitro testing. The in vitro tests were developed to apply repetitive sliding motion to the leads, assuming that a single heartbeat corresponds to a single sliding cycle.…”