Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing: The LIFE-LBBAP Study

Area of Science:

• Cardiology
• Cardiac Pacing
• Electrophysiology

Background:

• Left bundle branch area pacing (LBBAP) is increasingly used globally.
• Both lumenless leads (LLLs) and stylet-driven leads (SDLs) are employed for LBBAP.
• Concerns exist regarding lead integrity with LBBAP, as leads were designed for conventional pacing sites.

Purpose of the Study:

• To evaluate the lead integrity of pacing leads used for LBBAP.
• To assess lead fracture rates and locations in a large, real-world patient cohort undergoing LBBAP.

Main Methods:

• An observational study involving patients with successful LBBAP from 17 international centers.
• Collection of data on overall lead integrity, fracture rates, and fracture locations.
• Analysis of lead performance based on lead type (LLL vs. SDL).

Main Results:

• 8,255 patients with LBBAP were enrolled; 68% received LLLs and 32% received SDLs.
• Overall lead survival rate was 99.7% at a median follow-up of 16.4 months.
• Lead fractures occurred in 0.15% of patients (12/8,255), with SDLs showing significantly higher fracture rates (0.4%) than LLLs (0.04%).

Conclusions:

• LBBAP lead performance is high at midterm follow-up for both LLLs and SDLs.
• SDLs demonstrate a higher incidence of lead fracture compared to LLLs.
• Fracture 'hot spots' include the distal interelectrode segment for SDLs and the segment proximal to the ring electrode for LLLs.