Description Join host and HRS Digital Education Committee Chair Michael S. Lloyd, MD, FHRS and his guests Miguel A. Leal, MD, FHRS, and Jason T. Jacobson, MD, FHRS, live at HRX 2025. In this prospective series of 12 device-naïve patients (median LVEF ~30%), the authors attempted permanent implantation of a single-coil DF-4 ICD lead into the left bundle branch area (LBBA). They achieved successful implantation with adequate sensing and pacing in 75% of patients, and during short-term follow-up the lead and RV parameters remained stable; minor complications occurred in ~25% of patients (lead micro-dislodgment and septal perforations). The authors conclude that LBBA ICD lead implantation is feasible with current tools and acceptable short-term outcomes, but note the higher-than-expected minor complication rate and emphasize the need for dedicated toolkits, higher operator volume, and a procedural learning curve. Learning Objectives Describe the procedural feasibility, safety considerations, and short-term outcomes associated with left bundle branch area (LBBA) DF-4 defibrillator lead implantation. Identify key technical caveats and patient selection factors relevant to adopting this emerging pacing strategy in clinical practice. Article Information Permanent Left Budnle Branch Area DF-4 Debibrillator Lead Implantation Feasibility, Procedural Caveats, Safety, and Follow-Up Article Authors Anindya Ghosh, Chenni S. Sriram, Nibin Manu, Mullasari Ajit Sankaradas, Gaurav M. Upadhyay, Ulhas M. Pandurangi  Podcast Contributors Michael S. Lloyd, MD, FHRS  Jason T. Jacobson, MD, FHRS  Miguel A. Leal, MD, FHRS  All relevant financial relationships have been mitigated. Host Disclosure(s): M. Lloyd •Speaking/Teaching/Consulting: Medtronic, Arga Medtech, Circa Scientific   •Membership on Advisory Committees: Boston Scientific   ​Contributor Disclosure(s):    J. Jacobson •Stocks, Privately Held: Atlas 5D •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: Abbott Medical, CardioFocus, Inc. M. Leal •Speaking/Teaching/Consulting: Medtronic   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

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