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Observational Study
. 2025 Jan;11(1):158-170.
doi: 10.1016/j.jacep.2024.09.020. Epub 2024 Nov 20.

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

Jan De Pooter  1 , Alexander Breitenstein  2 , Emine Özpak  3 , Andreas Haeberlin  4 , Daniel Hofer  5 , Jean-Benoit Le Polain de Waroux  6 , Aurélien Wauters  7 , Tae-Hoon Kim  8 , So-Ryoung Lee  9 , Young Jun Park  10 , Michael Gobitz  2 , Grzegorz Kiełbasa  11 , Dipen Zalavadia  12 , Heli Tolppanen  13 , David Žižek  14 , Francesco Zanon  15 , Lina Marcantoni  15 , Shunmuga Sundaram Ponnusamy  16 , Jarkko Karvonen  13 , Oscar Cano  17 , Marek Jastrzebski  11 , Pugazhendhi Vijayaraman  12 , Haran Burri  18
Affiliations
Observational Study

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

Jan De Pooter et al. JACC Clin Electrophysiol. 2025 Jan.

Abstract

Background: 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.

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

Methods: 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.

Result: 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.

Conclusions: 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.

Keywords: lead fracture; left bundle branch area pacing; lumenless leads; stylet-driven leads.

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Conflict of interest statement

Funding Support and Author Disclosures Dr De Pooter has received speaker and consulting fees from Medtronic, Biotronik, Abbott, and Boston Scientific. Dr Breitenstein has received speaker and/or consulting fees from Abbott, Bayer Health Care, Biosense Webster, Biotronik, BMS/Pfizer, Boston Scientific, Cook Medical, Daiichi Sankyo, Medtronic, and Spectranetics/Philips. Dr Haeberlin has served as a consultant/proctor for Medtronic and Boston Scientific; has received travel fees/grants from Medtronic, Biotronik, Abbott, and Philips/Spectranetics without impact on personal remuneration; and is co-founder and clinical head of Act-Inno AG. Dr Hofer has received educational grants, consultant or speaker fees, and fellowship support from Abbott, Medtronic, Biotronik, Boston Scientific, Biosense Webster, Novartis, Bayer, Pfizer, and Spectranetics. Dr Le Polain de Waroux has received speaker and consulting fees from Medtronic, Biotronik, Abbott, and Boston Scientific. Dr Wauters has received consulting and speakers fees from Abbott, Biotronik, Boston Scientific, Medtronic, and MicroPort. Dr Kim has received speaker fees and/or research support from Biotronik, Abbott, Boston Scientific, and Medtronic. Dr Kiełbasa has received consulting fees from Medtronic and Biotronik. Dr Tolppanen has received consulting fees from Biotronik. Dr Žižek has received Advisory Board, consulting, and proctorship fees from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Zanon has received speaker and consulting fees from Medtronic, Biotronik, Abbott, and Boston Scientific. Dr Marcantoni has received speaker fees from Biotronik. Dr Sundaram Ponnusamy has received Consulting fees and a research grant from Medtronic; and consulting fees from Abbott. Dr Karvonen has received speaker and/or consulting fees from Medtronic, Biotronik, Abbott, and Boston Scientific; and has served on an Advisory Board for Medtronic. Dr Cano has received Advisory Board, speaker, and consulting fees from Abbott, Biotronik, Boston Scientific, Medtronic, and MicroPort; and research support from Medtronic. Dr Jastrzebski has received Advisory Board, speaker, consulting, and proctorship fees from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Vijayaraman has received Advisory Board and speaker fees and/or institutional research and fellowship support from Medtronic; consulting fees from Abbott and Biotronik; honoraria from Boston Scientific; and holds a patent for HBP delivery tool. Dr Burri has received Advisory Board and speaker fees and/or institutional research and fellowship support from Abbott, Biotronik, Boston Scientific, Medtronic, and MicroPort. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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