Permanent Left Bundle Branch Area DF‐4 Defibrillator Lead Implantation—Feasibility, Procedural Caveats, Safety, and Follow‐Up

ABSTRACT Introduction Permanent implantation of a DF‐4 implantable cardiac defibrillator (ICD) lead in the left bundle branch area (LBBA‐ICD) is the next paradigm in amalgamating cardiac resynchronization therapy (CRT) and defibrillation. We systematically investigated feasibility/success rate, procedural caveats, and complications associated with a permanent DF‐4 LBBA ICD implant and pertinent data at short‐term follow‐up. Methods We prospectively attempted implantation of 7 Fr Durata (Abbott, Chicago, IL, USA) single coil DF‐4 ICD lead at the LBBA using a fixed‐curve non‐deflectable CPS locator delivery sheath. Standard criteria defined LBBA capture. Relevant sensing/pacing, defibrillation, radiographic, and echocardiographic parameters testing were recorded at implant, discharge and 5‐month follow‐up. Results We enrolled 12 consecutive cardiac device‐naïve patients (median age 67.5 years, male 91.7%, median LVEF 30%, median septal thickness 9 mm, median QRS duration 140 ms, class I CRT indication 58.3%, primary prevention ICD indication 75%). Minor complications (two transeptal perforations and one micro‐dislodgment) were noted in 3/12 (25%) patients. Successful permanent LBBA ICD implant with adequate sensing/pacing was achieved in 9/12 (75%) subjects. Sustained ventricular fibrillation (VF) was inducible in 7/9 patients with successful implants with effective sensing and defibrillation in all. Follow‐up device‐related and echocardiographic parameters were similar at discharge and 5‐month follow‐up. Conclusion Permanent DF‐4 LBBA ICD implant is feasible and successful in 75% of patients with an indication for ICD. With dedicated toolkits, higher volumes, and an obligate learning curve, the higher‐than‐expected frequency (25%) of minor complications may be ameliorated. Short‐term data regarding lead and selected RV parameters remained favorable.