Arrhythmias & electrophysiologyMeta-analysis
Rare complications of left bundle branch area pacing: A systematic review of case-based evidence
- Systematic review of case-based evidence
- Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020
- narrative synthesis
Authors' conclusion
Rare complications of LBBAP reflect the transseptal nature of the procedure and can be grouped into 5 clinical phenotypes. Recognition requires the integration of symptoms, device data, and imaging. Normal device parameters do not exclude clinically relevant structural complications. A phenotype-based approach may help to guide diagnosis and management in clinical practice.
Study context
- Population
- Case reports and small case series describing left bundle branch area pacing (LBBAP)-related complicationsreports included
- Participants
- 67 reports
Further pooled results
Categories of complications
- Complications grouped into 5 categories: septal injury, vascular injury, valvular/subvalvular damage, mechanical or lead-related complications, and electrophysiological disturbances
Septal injury
- Most frequently reported complication, ranging from intraseptal hematoma to delayed perforation presenting with arrhythmias, thromboembolism, or tamponade
Vascular complications
- Coronary and venous injuries, sometimes mimicking acute coronary syndromes
Valvular and mechanical complications
- Occurred despite normal electrical parameters
Electrophysiological complications
- Ventricular arrhythmias, pacing-induced cardiomyopathy, and T-wave oversensing
Management
- Varied according to the clinical presentation, from conservative observation to lead revision or interventional treatment
Original publication
Rare complications of left bundle branch area pacing: A systematic review of case-based evidence. Heart Rhythm. Published 23 August 2026. doi:10.1016/j.hrthm.2026.08.019
Summarised from the published abstract; every number is checked against it