Severe Acute Coronary Syndrome After Left Bundle Branch Area Pacing: Multidisciplinary Team-Guided Management of Intraseptal Hematoma.
| Title: | Severe Acute Coronary Syndrome After Left Bundle Branch Area Pacing: Multidisciplinary Team-Guided Management of Intraseptal Hematoma. |
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| Authors: | Kieu ND; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Nguyen QH; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam. Electronic address: nguyenquochoang.1702@gmail.com.; Vo TD; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Nguyen Khac LS; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Tran LUP; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.; Nguyen TT; Department of Arrhythmology, Cho Ray Hospital, Ho Chi Minh City, Vietnam; Ministry of Health of Vietnam, Hanoi, Vietnam. |
| Source: | JACC. Case reports [JACC Case Rep] 2025 Dec 03; Vol. 30 (39), pp. 106148. |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Inc Country of Publication: Netherlands NLM ID: 101757292 Publication Model: Print Cited Medium: Internet ISSN: 2666-0849 (Electronic) Linking ISSN: 26660849 NLM ISO Abbreviation: JACC Case Rep Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Amsterdam] : Elsevier Inc., [2019]- |
| Abstract: | Background: Left bundle branch area pacing (LBBAP) is a physiologic pacing technique increasingly used for bradyarrhythmia and heart failure indications. Rare complications include interventricular septal hematoma (IVSH), which may compress collateral flow and present as acute myocardial infarction.; Case Summary: A 79-year-old woman with chronic total occlusion of the left anterior descending artery and prior stenting of the right coronary artery underwent dual-chamber pacemaker implantation with LBBAP. Twelve hours later, she developed chest pain, pulmonary edema, new anterior ST-segment elevation, and a drop in left ventricular ejection fraction from 54% to 33%. Echocardiography revealed a septal hematoma (14 × 24 mm) surrounding the pacing lead.; Discussion: A multidisciplinary team including electrophysiology, interventional cardiology, heart failure, and cardiac surgery considered lead revision, percutaneous coronary intervention, coronary artery bypass grafting, and conservative care. Given stable pacing parameters, collateral-dependent chronic total occlusion of the left anterior descending artery, and regression of hematoma on surveillance, conservative management was chosen with staged antithrombotic reintroduction and surgical standby.; Conclusions: IVSH can precipitate Killip class III ST-segment elevation myocardial infarction after LBBAP without new coronary occlusion. Multidisciplinary team-guided conservative therapy with close surveillance can be safe in selected cases.; (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
| References: | JACC Case Rep. 2023 May 18;16:101889. (PMID: 37396325); Eur Heart J. 2018 Jan 7;39(2):119-177. (PMID: 28886621); J Cardiovasc Dev Dis. 2024 Feb 01;11(2):. (PMID: 38392266); Can J Cardiol. 2017 Dec;33(12):1736.e1-1736.e3. (PMID: 29173611); Eur Heart J. 2019 Jan 7;40(2):79-80. (PMID: 30615155); JACC Case Rep. 2023 May 17;16:101887. (PMID: 37396319); Front Cardiovasc Med. 2021 Sep 28;8:744079. (PMID: 34651029); JACC Clin Electrophysiol. 2023 Jan;9(1):142-144. (PMID: 36697195) |
| Contributed Indexing: | Keywords: acute coronary syndrome; acute heart failure; cardiac pacemaker; complication |
| Entry Date(s): | Date Created: 20251205 Date Completed: 20251205 Latest Revision: 20260203 |
| Update Code: | 20260203 |
| PubMed Central ID: | PMC12859573 |
| DOI: | 10.1016/j.jaccas.2025.106148 |
| PMID: | 41350028 |
| Database: | MEDLINE |
Case Reports; Journal Article