POCUS GUIDED CONSERVATIVE MANAGEMENT OF SEPTAL HEMATOMA: A RARE COMPLICATION OF HIS BUNDLE PACING
Recommended Citation
Toiv A, Andrews TQ, Goleniak R, Karmally R, Rudraiah L. POCUS GUIDED CONSERVATIVE MANAGEMENT OF SEPTAL HEMATOMA: A RARE COMPLICATION OF HIS BUNDLE PACING. J Am Coll Cardiol 2025; 85(12):3244.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
anticoagulant agent, lupitidine, troponin, adult, aged, case report, clinical article, complication, conference abstract, conservative treatment, contrast medium extravasation, coronary occlusion, diagnosis, dual chamber pacemaker, echocardiography, follow up, heart catheterization, heart right bundle branch block, hematoma, His bundle, His bundle pacing, human, interventricular septum, left coronary artery, male, point of care ultrasound, sick sinus syndrome, ST segment elevation, thorax pain
Abstract
Background: The introduction of His bundle pacing has shown significant electrophysiologic benefits but also comes with its own set of procedural complications. Point-of-care ultrasound (POCUS) is valuable in identifying these structural complications. Case A 75-year-old male with no cardiac history presented for sick sinus syndrome. He underwent successful placement of a permanent dual chamber pacemaker with a para-Hisian lead. One-hour post-procedure, he developed substernal chest pressure with ST elevation in lead III, a new RBBB, and troponin elevation (>20,000 ng/L). A POCUS showed concern for ventricular septal hematoma. Emergent cardiac catheterization ruled out coronary occlusion but revealed contrast extravasation from the left coronary artery into the ventricular septal wall. A follow-up TTE confirmed a 7.74 cm x 3.75 cm anechoic space within the ventricular septum protruding into the right ventricle and causing obstruction. Decision-making The ultrasound findings guided acute management leading to the decision to avoid anti-thrombotic therapy which would have increased the risk of hematoma expansion and progressive right ventricular obstruction. Conclusion This case highlights the role of POCUS and echocardiography in acute chest pain after intervention and provides rapid and effective means to identify structural complications. Additionally, interventricular septal hematoma following His bundle pacer placement is a rare complication that has not yet been described. [Formula presented]
Volume
85
Issue
12
First Page
3244
