PMC9845548_01
Left anterior oblique (LAO) projection demonstrating implantation depth during contrast dye injection at primary implantation.
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Implantation was performed as previously described by Huang and colleagues, resulting in stable and good pacing thresholds, pacing impedance, and sensing amplitudes (0.5 V @ 0.4 ms; 351 Omega unipolar, 526 Omega bipolar, 13.5 mV; Figure 1A) after a third positioning attempt.
A: Schematic structure of the Solia S lead (Biotronik) highlighting the conductor breaking point (black arrow). B: Right anterior oblique (RAO) projection demonstrating lead fracture distal to ring electrode (white arrow). C: Image of the explanted lead breaking point marked with white arrow.
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By fluoroscopy, the lead was in place in the ventricular septum, but a possible conductor fracture was visualized by a suggestive lead movement just before the ring electrode at the entry point into the septum (Figure 2A-2C and Supplemental Video).
A: Left anterior oblique (LAO) projection demonstrating implantation depth during contrast dye injection at lead revision. B: Left bundle branch area pacing in 12-lead electrocardiogram after lead revision (50 mm/s).
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A new LBBAP lead (Biotronik Solia S60) was inserted as described above in a slightly more apical direction with a deeper penetration into the RV septum using a Biotronik Selectra 3D 40-42 sheath, resulting in physiological pacing (Figure 3A and 3B).