The Lead Episode 125: A Discussion of Permanent Left Bundle Branch Area DF-4 Defibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up, LIVE at HRX-A Discussion of Permanent Left Bundle Branch Area DF-4 Defibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up, LIVE at HRX (Bonus Video)

A Discussion of Permanent Left Bundle Branch Area DF-4 Defibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up, LIVE at HRX (Bonus Video)

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Video Summary

This episode of The Lead discusses a 2025 study by Dr. Ghosh on left bundle branch area pacing (LBBAP) using a standard DF4 ICD lead, marking a significant innovation in cardiac pacing. The small prospective study involved 12 patients needing defibrillation, with 75% successful lead implantation targeting left ventricular septum or left posterior fascicle areas. The study highlighted challenges like limited sheath maneuverability, prolonged procedure times, and lead positioning concerns, yet demonstrated effective defibrillation in inducible ventricular arrhythmias. Discussants emphasized this as proof-of-concept, underscoring the potential for reducing hardware complexity in cardiac devices. Concerns remain about long-term lead durability in the septum, extraction difficulties, and valve interference. Emerging technologies, like smaller lead designs, may improve outcomes. Both experts advised caution, highlighting patient consent and careful innovation at specialist centers. Overall, this study opens pathways for integrating conduction system pacing with ICD therapy, aiming to enhance physiological pacing while limiting procedural complexity and future complications.

Keywords

Left Bundle Branch Area Pacing

DF4 ICD Lead

Cardiac Pacing Innovation

Defibrillation Study 2025

Conduction System Pacing