case_images: PMC10801130_01
case_images: A: Initial lead position and the lead was retracted owing to septal perforation. B-F: Sequential images of contrast media injection with septal retention and immediate wash-out: left anterior oblique view (B-E) and right anterior oblique view (F). Retrograde filling of coronary veins (white arrow) and septal tunnel developed by the initial lead (arrowhead) are shown.
case_images: gr1.jpg
case_images: PMC10801130_01_gr1.jpg
case_images: fig1
case_images: Upon injection of contrast medium through the guiding catheter, the lead was found to be screwed into the septum at a depth of 11 mm (Figure 1A, Supplemental Video 1). This revealed staining within the septal wall and coronary vein opacification, with the contrast rapidly washing out (Figure 1B-1F).
case_images: A: Electrocardiogram (ECG) of successful left bundle branch area pacing by repositioned lead. B: Typical qR pattern in V1 lead and with a left ventricular activation time (LVAT) of 78 ms was observed. C: A change of ECG morphology with prolongation of LVAT after injection of contrast material into septum.
case_images: gr2.jpg
case_images: PMC10801130_01_gr2.jpg
case_images: fig2
case_images: Approximately 5 mm below the initial placement, the lead was repositioned with an LVAT of 78 ms and impedance of 570 Omega, both showing good values (Figure 2A and 2B). Lead impedance dropped to 475 Omega, and LVAT extended to 113 ms along with the disappearance of the late R wave in the V1 lead (Figure 2C).