Screw-in attempts and success rates in left bundle branch area pacing lead implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) represents a novel cardiac pacing approach that overcomes limitations of conventional right ventricular (septo-) apical pacing. Feasibility and early safety have been shown previously. However, technical limitations (non-dedicated leads, limited availability of suitable implantation sheats) still may preclude successful conduction system pacing (CSP) lead implantation. So-called drilling and entanglement effects can prevent lead implantation at a suitable site and multiple screw-in attempts may be required. However, lead implantation may ultimately still be unsuccessful. Purpose To evaluate the number of total screw-in attempts until abandonment of LBBAP lead implantation during the procedure. Methods We prospectively assessed 170 consecutive LBBAP lead implantation attempts at our center from 09/2021 to 11/2022. All implanters had previous experience with His-bundle pacing lead implantation. Successful conduction system pacing was established according to standard criteria (R-wave peak time in V6, V1-V6-interpeak interval, programmed stimulation or visibility of a left bundle potential) and pacing thresholds