Interventricular septal hematoma following left bundle branch area pacing: a rare case with atypical arrhythmic presentation
- Author:
Seongjin PARK
1
;
Juwon KIM
;
Seung-Jung PARK
;
Kyoung-Min PARK
;
Young Keun ON
;
Ju Youn KIM
Author Information
- Publication Type:Case Report
- From:International Journal of Arrhythmia 2026;27(1):e7-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Left bundle branch area pacing (LBBAP) provides physiologic ventricular activation but requires deep lead penetration into the interventricular septum, which can rarely cause various complications.Case presentation: A 57-year-old woman with high-degree atrioventricular block underwent dual-chamber pacemaker implantation with stylet-driven LBBAP via the left axillary vein. Within hours, she developed nausea, vomiting, and frequent ventricular premature contractions with non-sustained ventricular tachycardia, while remaining hemodynamically stable. Transthoracic echocardiography revealed a well-circumscribed echo lucent mass in the mid interventricular septum (15.6 × 24.7 mm) consistent with hematoma, without pericardial effusion or left ventricular outflow tract obstruction. In the absence of clinical deterioration, a conservative strategy with close rhythm monitoring and serial echocardiography was chosen. The hematoma regressed progressively with near-complete resolution at two weeks, and the patient remained asymptomatic with stable lead function at 6-month follow-up.
Conclusions:Interventricular septal hematoma is a rare complication of LBBAP that may present predominantly with ventricular arrhythmia. In hemodynamically stable patients without mechanical compromise, careful surveillance can allow successful conservative management without surgical intervention.
