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

Left bundle branch area pacing (LBBAP) has gained increased adoption globally with the use of both lumenless leads (LLLs) and stylet-driven leads (SDLs). As these leads have been developed for conventional endocardial pacing sites, concerns remain regarding the lead integrity with LBBAP.

This study evaluates lead integrity of pacing leads used for LBBAP in a large, real-world cohort of patients with LBBAP.

Patients with successful LBBAP from 17 international centers were enrolled in this observational study. Data on overall lead integrity, fracture rates, and locations of fractures were collected.

The study enrolled 8,255 patients with LBBAP (age 73 ± 13 years, 42% female, 68% LLLs, and 32% SDLs). Overall lead survival rate was 99.7% with median follow-up of 16.4 (Q1-Q3: 6.4-28.8) months. Lead fracture occurred in 12 of 8,255 (0.15%) patients. Lead fracture rates of LLLs occurred in 2 of 5,609 (0.04%) vs 10 of 2,646 (0.4%) patients for SDLs, during a follow-up of 19.5 (Q1-Q3: 9.7-33) and 10.3 (Q1-Q3: 2.9-19.7) months, respectively (P < 0.001). SDL fractures occurred at 13.9 (Q1-Q3: 6.1-17.7) months after implant, whereas 2 LLL fractures occurred at 21 and 31.4 months. SDL and LLL conductor fractures were observed in 7 of 17 and 2 of 17 centers, respectively. Confirmed fractures of the SDL lead originated within the interelectrode lead segment, whereas LLL fractures occurred proximal to the ring.

LBBAP lead performance of LLLs and SDLs is high at midterm follow-up. SDLs exhibit higher rates of fracture compared to LLLs. Hot spots for conductor fracture are the distal interelectrode segment in SDLs and the segment proximal to the ring electrode in LLLs.