case_images: PMC8505742_01
case_images: (A) Fluoroscopic images at RAO 30  and LAO 30  at the site A which represents where the pacing lead got for the first time. (B) The LBB potential noted and the characteristics of paced QRS morphology at the site A. (C) Fluoroscopic images at RAO 30  and LAO 30  at the site B. (D) The LBB potential noted, the characteristics of paced QRS morphology and ventricular COI at the site B. RAO, right anterior oblique; LAO, left anterior oblique; LBB, left bundle branch; COI, current of injury.
case_images: fcvm-08-744079-g0001.jpg
case_images: PMC8505742_01_fcvm-08-744079-g0001.jpg
case_images: F1
case_images: At the site A, we failed to capture the LBB (Figures 1A,B) even when we tried to screw deeper where we recorded a smaller LBB potential. Then the lead was moved inferiorly and posteriorly to the site B, LBBP was finally successfully achieved with a larger LBB potential and pacing threshold of 0.5 V/0.5 ms (Figures 1C,D).
case_images: (A) ECG during intrinsic rhythm. (B) ECG recorded when chest pain occurred. (C) ECG recorded when chest pain was relieved. ECG, electrocardiogram.
case_images: fcvm-08-744079-g0002.jpg
case_images: PMC8505742_01_fcvm-08-744079-g0002.jpg
case_images: F2
case_images: A 67-year-old female presenting with dizziness was diagnosed with high-degree atrioventricular block (Figure 2A) and referred for pacemaker implantation in August 2020. The ST-segment depression was recorded during intrinsic rhythm by programming the device to a lower pacing rate (Figure 2B) and pacing parameters remained stable. The symptoms were relieved quickly, and her blood pressure increased with a normalized ST segment half an hour later (Figure 2C).
case_images: (A) The echocardiogram indicated interventricular septal hematoma measuring 8 mm in width. (B) Contrast agent retention in the interventricular septum. (C) The echocardiography confirmed the hematoma has resolved. (D) No contrast agent overflow was found in the interventricular septum. RAO, right anterior oblique; CAU, caudal; LAO, left anterior oblique.
case_images: fcvm-08-744079-g0003.jpg
case_images: PMC8505742_01_fcvm-08-744079-g0003.jpg
case_images: F3
case_images: The bedside echocardiogram revealed an interventricular septal hematoma measuring 8 mm in width without pericardial effusion (Figure 3A). Immediate coronary angiography demonstrated contrast agent overflow and retention in the interventricular septum (IVS) (Figure 3B). After 1 month, echocardiography, CTA confirmed the hematoma had resolved (Figures 3C, 4B). No contrast agent overflow was found in the interventricular septum (Figure 3D) at 1-month follow-up.
case_images: (A) CTA showed a hematoma in the basal segment of the interventricular septum in the acute period after LBBP. On non-contrast CTA, a high-density thickening in the interventricular septum was found. Post contrast, no significant change in the enhancement was observed. (B) CTA confirmed the hematoma has resolved at the 1-month follow-up. CTA, computed tomography angiography.
case_images: fcvm-08-744079-g0004.jpg
case_images: PMC8505742_01_fcvm-08-744079-g0004.jpg
case_images: F4
case_images: The next day, computed tomography angiography (CTA) showed a hematoma in the basal segment of the IVS (Figure 4A). After 1 month, echocardiography, CTA confirmed the hematoma had resolved (Figures 3C, 4B).