Intraluminal Lead Entry Into the Left Anterior Descending Coronary Artery With Left Bundle Branch Area Pacing

BACKGROUND: Left bundle branch area pacing (LBBAP) is increasingly adopted for transvenous pacing. We report intraluminal lead entry into the main left anterior descending (LAD) coronary artery after deployment of an LBBAP lead. CASE SUMMARY: An 83-year old woman with tachy-brady syndrome underwent LBBAP with an Abbott UltiPace 58cm active fixation lead. The procedure was complicated by acute chest pain with associated ST-segment elevation in the anteroseptal leads. An attempt to retract the conduction system pacing lead helix was made; however, it could not be retracted entirely. An invasive coronary angiogram demonstrated TIMI flow grade 0 in the distal LAD coronary artery vessel. After a consensus decision, she was managed conservatively; her angina and ST-segment elevation resolved. She was discharged on day 3 postimplantation with stable lead parameters. DISCUSSION: This case demonstrates the potential risk of intraluminal lead entry into the main LAD coronary artery after deployment of a conduction system pacing lead.