Lead-to-lead interaction leading to left bundle branch area pacing lead failure

Atrioventricular (AV) node ablation and conduction system pacing using left bundle branch area pacing (LBBAP) is an excellent option for patients with atrial fibrillation and rapid ventricular rates refractory to medical therapy.1,2 Patients with severely reduced left ventricular systolic function benefit from implantable cardioverter-defibrillator (ICD) for prevention of sudden cardiac death.3 Biventricular pacing using coronary vein lead has been shown to reduce heart failure hospitalization and mortality compared to right ventricular pacing in patients undergoing AV node ablation,4 but may be limited by anatomical challenges, nonphysiologic biventricular activation, phrenic nerve stimulation, and/or high pacing thresholds.