# Late dislodgement of left bundle branch pacing lead and failure of left ventricle capture management algorithm

## TL;DR

A man with heart failure had a successful device implant, but later experienced lead dislodgement and heart function decline due to a faulty algorithm.

## Contribution

Highlights a rare complication of left bundle branch pacing and a failure in capture management algorithms.

## Key findings

- Late lead dislodgement occurred 10 months after implantation.
- LV capture management algorithm failed due to misinterpretation of conducted beats.
- Lead replacement restored normal left ventricular function.

## Abstract

A 74-year-old man with nonischemic cardiomyopathy, LV ejection fraction (LVEF) of 20 % and left bundle branch block (LBBB) underwent successful cardiac resynchronization therapy defibrillator (CRT-D) implantation utilizing LBBP lead in the LV port. Despite normalization of LVEF at 6 months, patient presented with late lead dislodgment at 10 months post-implant and decline in LV function. LV capture management algorithm was inactive due to sensing of conducted beat as ventricular fibrillation sensed event. Removal and replacement of LBBP lead resulted in recovery of LV function.