Discussion
Recent growing interest for tissue conduction pacing has incited pacemaker companies to develop their own dedicated implantation tools and solutions. The Select Secure 3830 lead (Medtronic Inc., Minneapolis, MN, USA) is characterized by a unique narrow caliber Lumen-Less (LL) isodiametric design with an exposed helix and is implanted using a dedicated preshaped sheath (C315HIS, Medtronic Inc.). Recently, Zanon et al. described the feasibility of LBBAP using conventional SD leads with an extendable helix, also delivered through a dedicated preshaped sheath (Selectra 3D, Biotronik, limited market release). De Pooter et al. demonstrated comparably high implant success rates in LBBAP with both types of leads. Both publications describe the preparation and implantation technique of SD leads for LBBAP but no specific recommendations are provided on how to troubleshoot difficult implantations, with reference in particular to their removal and repositioning.