Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture
- 1Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
Abstract
Background: Left bundle branch area pacing (LBBAP) requires delivery-sheath support for implantation and revision. Redo procedures for lead-related complications may require additional venous puncture to regain access.
Case Summary: A 79-year-old man underwent LBBAP for complete atrioventricular block. Four days later, abrupt threshold elevation and loss of capture occurred. Fluoroscopy showed complete interventricular septal perforation with lead-tip migration into the left ventricular cavity. Lead revision was performed using a sheath-assisted access-preserving technique without additional venous puncture. A modified 4-F short sheath was advanced over the existing lead, allowing guidewire insertion, sheath upsizing, and successful LBBAP lead reimplantation.
Discussion: Delayed septal perforation is a rare but recognized LBBAP complication. This case demonstrates a simple technique using standard sheaths and guidewires that may reduce invasiveness during selected redo LBBAP procedures.
Take-Home Message: Sheath-assisted access preservation can facilitate LBBAP lead revision without additional venous puncture.
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BibTeX
@article{hiruma2026sheathassisted,
title = {{Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture}},
author = {Yohei Hiruma and Noriaki Moriyama and Hikaru Tanemura and Kunihiko Shimizu and Masato Murakami and Shigeru Saito},
journal = {JACC Case Reports},
year = {2026},
month = aug,
doi = {10.1016/j.jaccas.2026.109785},
url = {https://doi.org/10.1016/j.jaccas.2026.109785},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sheath-Assisted Redo Left Bundle Branch Area Pacing Without Additional Venous Puncture
AU - Yohei Hiruma
AU - Noriaki Moriyama
AU - Hikaru Tanemura
AU - Kunihiko Shimizu
AU - Masato Murakami
AU - Shigeru Saito
PY - 2026
DA - 2026/08/10
JO - JACC Case Reports
DO - 10.1016/j.jaccas.2026.109785
UR - https://doi.org/10.1016/j.jaccas.2026.109785
AB - Background: Left bundle branch area pacing (LBBAP) requires delivery-sheath support for implantation and revision. Redo procedures for lead-related complications may require additional venous puncture to regain access. Case Summary: A 79-year-old man underwent LBBAP for complete atrioventricular block. Four days later, abrupt threshold elevation and loss of capture occurred. Fluoroscopy showed complete interventricular septal perforation with lead-tip migration into the left ventricular cavity. Lead revision was performed using a sheath-assisted access-preserving technique without additional venous puncture. A modified 4-F short sheath was advanced over the existing lead, allowing guidewire insertion, sheath upsizing, and successful LBBAP lead reimplantation. Discussion: Delayed septal perforation is a rare but recognized LBBAP complication. This case demonstrates a simple technique using standard sheaths and guidewires that may reduce invasiveness during selected redo LBBAP procedures. Take-Home Message: Sheath-assisted access preservation can facilitate LBBAP lead revision without additional venous puncture.
SN - 2666-0849
ER -