Inadvertent septal perforation during conduction system pacing device implant: A case report

Jurgen Shtembari, Dhan Bahadur Shrestha, Roderick Tung, Gaurav A. Upadhyay

Research output: Contribution to journalArticlepeer-review


Background: There has been recent growing interest in the use of conduction system pacing (CSP) for both bradycardia and heart failure indications. There remains a paucity of data, however, regarding complications related to the intraventricular septum associated with CSP implant and the management of these events. Case summary: We present a case of a patient with non-ischemic dilated cardiomyopathy presenting for cardiac resynchronization therapy in whom left bundle branch area pacing was complicated with interventricular septal perforation and managed intra-procedurally with repositioning of the lead to provide His bundle pacing (HBP) for QRS correction of underlying left bundle branch block. Post-procedure echocardiography did not show persistent ventricular septal defect. Left ventricular ejection fraction improved from 13% four months before implant to 30% at 32 months post-implant. Corrective HBP pacing thresholds showed a rise at 3-year follow-up. Discussion: Interventricular septal perforation during CSP is a possible complication during lead fixation. Pre-operative septal assessment with imaging can be helpful to provide important septal anatomical features. Septal perforation can be managed appropriately with lead repositioning intra-procedurally and close follow-up.

Original languageEnglish (US)
Article numberytae106
JournalEuropean Heart Journal - Case Reports
Issue number3
StatePublished - Mar 1 2024


  • Cardiac resynchronization therapy
  • Case report
  • Conduction system pacing
  • His bundle pacing (HBP)
  • Interventricular septal perforation
  • Left bundle branch area pacing (LBBAP)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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