{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T14:59:58Z","timestamp":1771685998389,"version":"3.50.1"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conductor externalization is a recognized mechanism of transvenous lead failure. In left-ventricular (LV) coronary-sinus (CS) leads, irreversible electrical failure requiring extraction is uncommon. Conduction system pacing with left bundle branch area pacing (LBBAP) can provide a physiological alternative when CS re-implantation is not feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 67-year-old man with non-ischaemic cardiomyopathy and reduced LV ejection fraction (EF) secondary to infective endocarditis with severe aortic\/mitral regurgitation underwent bioprosthetic aortic valve replacement with mitral repair and cardiac resynchronization therapy-defibrillator implantation in 2021 after drug-associated torsade de pointes and ventricular fibrillation arrest. He underwent transcatheter edge-to-edge mitral repair in June 2024. At routine review in October 2024, he was clinically well and asymptomatic; LV lead testing showed very high impedance (&amp;gt;3000\u2005\u03a9), threshold 5.75\u2005V at 1.0\u2005ms, and intermittent loss of capture. Chest radiography showed stable lead position. At revision in March 2025, the extracted LV lead displayed conductor externalization, and CS re-implantation was precluded by a small, unwireable anterolateral branch. LBBAP was implanted with low capture threshold and stable sensing; the generator was replaced without complications. At 1-month follow-up, the LV EF was 20\u201325% (previously 10\u201315% in 2024); by August 2025 he was New York Heart Association (NYHA) class I and euvolaemic with stable weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates persistent electrical failure in LV CS lead with extraction-confirmed conductor externalization, contrasts with prior reports of electrically silent or transient disturbance, and supports LBBAP as a practical physiological option when CS re-implantation is not feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag047","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:59:46Z","timestamp":1769086786000},"source":"Crossref","is-referenced-by-count":0,"title":["Irreversible left-ventricular lead electrical failure from conductor externalization managed with left bundle branch area pacing: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6226-1902","authenticated-orcid":false,"given":"Jaber","family":"Almohammad","sequence":"first","affiliation":[{"name":"London Health Sciences Centre Research Institute, Western University , 339 Windermere Road, London, ON N6A 5A5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Almarzuqi","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre Research Institute, Western University , 339 Windermere Road, London, ON N6A 5A5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habib Rehman","family":"Khan","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre Research Institute, Western University , 339 Windermere Road, London, ON N6A 5A5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,25]]},"reference":[{"key":"2026022109013904100_ytag047-B1","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.hrthm.2011.12.019","article-title":"Riata implantable cardioverter-defibrillator lead failure: analysis of explanted leads with a unique insulation defect","volume":"9","author":"Hauser","year":"2012","journal-title":"Heart Rhythm"},{"key":"2026022109013904100_ytag047-B2","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1161\/CIRCEP.112.975755","article-title":"Prevalence and presentation of externalized conductors and electrical abnormalities in Riata defibrillator leads after fluoroscopic screening: report from the Netherlands Heart Rhythm Association Device Advisory Committee","volume":"5","author":"Theuns","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026022109013904100_ytag047-B3","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/pace.12563","article-title":"Electrical dysfunction associated with conductor externalization of a silicone left ventricular lead","volume":"38","author":"Mendenhall","year":"2015  1","journal-title":"Pacing Clin Electrophysiol"},{"key":"2026022109013904100_ytag047-B4","author":"Jude"},{"key":"2026022109013904100_ytag047-B5","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1007\/s00380-021-02016-5","article-title":"Long-term outcomes of left bundle branch area pacing versus biventricular pacing in patients with heart failure and complete left bundle branch block","volume":"37","author":"Hua","year":"2022  1","journal-title":"Heart Vessels"},{"key":"2026022109013904100_ytag047-B6","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.15420\/aer.2023.15","article-title":"The emerging role of left bundle branch area pacing for cardiac resynchronisation therapy","volume":"12","author":"Diaz","year":"2023","journal-title":"Arrhythm Electrophysiol Rev"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag047\/66569072\/ytag047.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/2\/ytag047\/66569072\/ytag047.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/2\/ytag047\/66569072\/ytag047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T14:01:55Z","timestamp":1771682515000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag047\/8440698"}},"subtitle":[],"editor":[{"given":"Henrike Aenne Katrin","family":"Hillmann","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Altom","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Feickert","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,25]]},"references-count":6,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag047","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,25]]},"article-number":"ytag047"}}