{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:26:44Z","timestamp":1792787204638,"version":"4.5.0"},"reference-count":16,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pacing leads with extendable\u2010retractable helix (EHL) are alternatives to fixed\u2010helix leads (FHL) for conduction system pacing (CSP), but data on handling characteristics are limited. This study evaluated a dual\u2010center experience of lead handling and performance during CSP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Consecutive patients with His\u2010bundle pacing (HBP) or left bundle branch pacing (LBBP) were evaluated for the primary outcome of lead failure, defined as structural damage to the lead necessitating lead replacement. Differences in pacing characteristics were compared. Among 280 patients (mean age 74\u2009\u00b1\u200911\u2009years, 44% male, 50% LBBP), 246 (88%) received FHL and 34 (12%) received EHL. Of 299 leads used, lead failure occurred more frequently among patients with EHL than FHL (29% vs. 2%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), regardless of CSP modality. Majority of damaged leads (89%) in the form of helix deformation were successfully removed, with failure occurring in only two patients, both EHL, leading to helix fracture and retention within the septal myocardium. EHL, compared to FHL, was associated with 25\u2010fold increased odds of lead failure (odds ratio: 25.21, 95% confidence interval: 7.35\u201386.51), and persisted after adjustment in turn for age, pacing modality and indication. CSP implant success rates did not differ by lead design (FHL 80% vs.\u00a0EHL 71%, <jats:italic>p<\/jats:italic>\u2009=\u2009.18), with similar pacing thresholds at implant and follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Helix deformation and fracture were more frequent with EHL in CSP despite similar implant success. These findings have significant implications for lead selection during CSP and raises concerns about the long\u2010term extractability of EHL in CSP.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15528","type":"journal-article","created":{"date-parts":[[2022,5,7]],"date-time":"2022-05-07T05:38:50Z","timestamp":1651901930000},"page":"1550-1557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Use of extendable helix leads for conduction system pacing: Differences in lead handling and performance lead design impacts conduction system pacing"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7273-6883","authenticated-orcid":false,"given":"Eugene S. J.","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"},{"name":"Yong Loo Lin School of Medicine National University Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie\u2010Ying","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Boey","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ng Teng Fong General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Soh","sequence":"additional","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming G.","family":"Sim","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine National University Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wee\u2010Tiong","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"},{"name":"Yong Loo Lin School of Medicine National University Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swee\u2010Chong","family":"Seow","sequence":"additional","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"},{"name":"Yong Loo Lin School of Medicine National University Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-4905","authenticated-orcid":false,"given":"Pipin","family":"Kojodjojo","sequence":"additional","affiliation":[{"name":"Department of Cardiology National University Heart Centre  Singapore Singapore"},{"name":"Yong Loo Lin School of Medicine National University Singapore  Singapore Singapore"},{"name":"Department of Cardiology Ng Teng Fong General Hospital  Singapore 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ACC\/AHA\/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines, and the heart rhythm society","volume":"140","author":"Kusumoto FM","year":"2019","journal-title":"Circulation"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2021.26"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2011.03153.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907555"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4003524"}],"container-title":["Journal of Cardiovascular 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