Delayed Partial Protrusion of the Lead After Left Bundle Branch Pacing: The Importance of Programming—A Case Report

Delayed lead perforation into the left ventricular (LV) cavity after left bundle branch area pacing (LBBAP) is less common than in the acute setting and could be associated with severe adverse events. We present the case of a young patient with symptomatic second-degree atrioventricular block who developed partial protrusion of the LBBAP lead into the LV cavity after discharge. While adequate conduction system capture was still seen with bipolar pacing, this potentially serious complication was self-diagnosed by the patient due to the initial ventricular pacing programming in a unipolar setting, which revealed the complete loss of capture.