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September 5, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

Procedural performance and safety of a helix locking tool for left bundle branch pacing: a prospective multicenter study

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Why the study?

Helix retraction during septal lead deployment can complicate LBBP procedures with extendable-retractable helix leads, but clinical performance data on a novel helix locking tool remain limited.

Comparison

Helix locking tool used during septal deployment of a stylet-driven lead

Design

Prospective multicenter registry

Follow-up

24 hours

Key result

The use of a helix locking tool during left bundle branch pacing was associated with a 90.8% procedural success rate, complete absence of helix retraction, and no tool-related acute adverse events.

Authors

DMDiego MenéndezEVErmengol VallèsACA Marco Del Castillo

Discussion

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Overview

May facilitate LBBP by reducing helix retraction; hypothesis-generating pending randomized confirmation.

Key Points

  • To evaluate the acute procedural performance and safety of a helix locking tool used during left bundle branch pacing lead implantation.
  • Prospective multicenter registry across 8 centers in Spain enrolling 87 consecutive patients undergoing left bundle branch pacing (LBBP).
  • Septal lead deployment was performed using a stylet-driven Tendril STS lead and CPS Direct 3D sheath paired with the helix locking tool (HLT), with 24-hour post-procedural follow-up.
  • Successful left bundle branch pacing was achieved in 79 of 87 patients (90.8%), with lead repositioning needed in 36 cases (41.4%; mean 2.3 ± 1.3 attempts).
  • Zero cases of helix retraction and zero acute adverse events related to the HLT were observed.
  • Three intraprocedural lead dislodgements (3.4%) occurred and were resolved without clinical consequences, with electrical parameters confirming conduction system capture.

Study Design

Type

Observational (n=87)

Multicenter

Yes

Structured PICO

P
Population
87 adult patients (mean age 77 years, 32.2% female) referred for de novo pacemaker or cardiac resynchronization therapy implantation undergoing left bundle branch pacing, evaluated for acute procedural outcomes.
I
Intervention
Helix locking tool (HLT) used during septal deployment of a stylet-driven Tendril STS lead and CPS Direct 3D sheath.
O
Outcome
Freedom from acute adverse events related to the HLT at 24-hour follow-up.safety

The use of a helix locking tool during left bundle branch pacing with stylet-driven leads is feasible and safe, achieving high procedural success without HLT-related acute complications.

Limitations

  • Absence of a control group without the HLT precludes estimating incremental benefit.
  • Only acute procedural outcomes and in-hospital electrical parameters were assessed, lacking long-term data.
  • Limited to a single lead model and delivery sheath, which may limit generalizability.
  • Operator experience varied across centers, introducing variability in procedural metrics.
  • Site-reported nature of complication adjudication may have limited the detection of minor adverse events.
  • Absence of a comparator group

Cite This Study

Menéndez et al. (2026) conducted an observational in Bradycardia or heart failure requiring cardiac device implantation (n=87). Helix locking tool (HLT) was evaluated on Freedom from acute adverse events related to the HLT during the procedure or within 24 hours after implantation. The use of a helix locking tool during left bundle branch pacing was associated with a 90.8% procedural success rate, complete absence of helix retraction, and no tool-related acute adverse events.

synapsesocial.com/papers/6a9c012d6b95aff0620ec810https://doi.org/10.1007/s10840-026-02423-6
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing2022 · 40 citations
  2. 2Repositioning and extraction of stylet‐driven pacing leads with extendable helix used for left bundle branch area pacing2021 · 35 citations
  3. 3First experience with a stylet-driven, fixed-helix lead designed for left bundle branch area pacing: the BIO-MASTER-CSP study2026
  4. 4Safety and long-term performance of the Medtronic 3830 lead in His-bundle vs. Left bundle branch area pacing: A single-center 5-year experience2024
  5. 5Unipolar diathermy applied via the terminal pin to release an entrapped LBBAP lead helix: A case report2026 · 1 citations