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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Case Report: Rupture of multiple perforating branches and fatal giant interventricular septal hematoma: a severe complication of left bundle branch area pacing

  • Jia Li1
  • Yue Bao1
  • Hongwei Han1
  • Hongwei Yi1
  • Hua Yan1
  1. 1Department of Cardiology, Wuhan Asia Heart Hospital
Open at sourceDOICite

Abstract

Background: Left bundle branch area pacing (LBBAP) is generally safe. Giant interventricular septal hematoma (IVSH) is an extremely rare complication of LBBAP. Previously reported cases had favorable outcomes, and no fatal cases have been reported to date.

Case summary: A 67-year-old male with 4 years of dilated cardiomyopathy (DCM) and refractory heart failure (HF) had a preoperative left ventricular ejection fraction (LVEF) of 13.2% and left bundle branch block. Following HF stabilization, cardiac resynchronization therapy defibrillator (CRTD) implantation was performed. Intraoperative LBBAP correction was unsatisfactory, and left ventricular lead placement failed. The patient developed chest pain and hypotension 5 h postoperatively. Bedside echocardiography detected a giant IVSH causing biventricular compression and pericardial effusion. Despite emergency extracorporeal membrane oxygenation (ECMO) support, pericardial drainage and interventional embolization, his condition worsened rapidly. Coronary angiography (CAG) identified rupture of multiple septal perforator branches. He succumbed to irreversible circulatory collapse 10 h after surgery.

Conclusion: Although most patients with LBBAP-associated IVSH achieve a favorable prognosis with timely intervention, the condition can progress rapidly and pose a life-threatening risk in those with end-stage severe HF.

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Cite

BibTeXRIS
BibTeX
@article{li2026case,
  title = {{Case Report: Rupture of multiple perforating branches and fatal giant interventricular septal hematoma: a severe complication of left bundle branch area pacing}},
  author = {Jia Li and Yue Bao and Hongwei Han and Hongwei Yi and Hua Yan},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1896456},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1896456/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Case Report: Rupture of multiple perforating branches and fatal giant interventricular septal hematoma: a severe complication of left bundle branch area pacing
AU  - Jia Li
AU  - Yue Bao
AU  - Hongwei Han
AU  - Hongwei Yi
AU  - Hua Yan
PY  - 2026
DA  - 2026/11/04
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1896456
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1896456/full
AB  - Background: Left bundle branch area pacing (LBBAP) is generally safe. Giant interventricular septal hematoma (IVSH) is an extremely rare complication of LBBAP. Previously reported cases had favorable outcomes, and no fatal cases have been reported to date.  Case summary: A 67-year-old male with 4 years of dilated cardiomyopathy (DCM) and refractory heart failure (HF) had a preoperative left ventricular ejection fraction (LVEF) of 13.2% and left bundle branch block. Following HF stabilization, cardiac resynchronization therapy defibrillator (CRTD) implantation was performed. Intraoperative LBBAP correction was unsatisfactory, and left ventricular lead placement failed. The patient developed chest pain and hypotension 5 h postoperatively. Bedside echocardiography detected a giant IVSH causing biventricular compression and pericardial effusion. Despite emergency extracorporeal membrane oxygenation (ECMO) support, pericardial drainage and interventional embolization, his condition worsened rapidly. Coronary angiography (CAG) identified rupture of multiple septal perforator branches. He succumbed to irreversible circulatory collapse 10 h after surgery.  Conclusion: Although most patients with LBBAP-associated IVSH achieve a favorable prognosis with timely intervention, the condition can progress rapidly and pose a life-threatening risk in those with end-stage severe HF.
SN  - 2297-055X
ER  -