The Lead Episode 146: Late Breaker Coverage: A Discussion of LEAP2: A First-In-Human Study of a Chronically-Implanted Novel Leadless Pacemaker for Conduction System Pacing

Welcome to the second episode this week in our triple header of late breaking clinical trials coverage from Heart Rhythm 2026 in Chicago. Host Christopher C Cheung, MD, MPH, FHRS is joined by Mihail G. Chelu, MD, PhD, FHRS and Derek Chew, MD, MS, FHRS for a conversation in Chicago. The LEAP2 trial, a first-in-human chronic feasibility study presented at Heart Rhythm 2026, evaluated a novel leadless pacemaker designed for conduction system pacing to more closely replicate physiologic cardiac activation. Early results from this small cohort demonstrated high implantation success, reliable device performance, and effective pacing of the heart's native conduction pathways through short-term follow-up. These findings highlight the potential of leadless conduction system pacing as an innovative alternative to traditional pacing strategies, pending further long-term data.   Learning Objectives Describe the principles and clinical rationale for conduction system pacing and how it differs from traditional right ventricular pacing.  Evaluate early safety and performance outcomes of novel leadless pacemaker systems designed for physiologic pacing.  Assess the potential clinical implications and future role of leadless conduction system pacing technologies in patients requiring permanent pacing.   Podcast Contributors Christopher C Cheung, MD, MPH, FHRS Mihail G. Chelu, MD, PhD, FHRS Derek Chew, MD, MS, FHRS   C. Cheung •Honoraria/Speaking/Teaching/Consulting: Medtronic, Biotronik, Biosense Webster, Abbott M. Chelu •Honoraria/Speaking/Teaching/Consulting: Impulse Dynamics, USA •Research: Abbott, Impulse Dynamics USA, VDI Technologies, PCORI, NIH/NHLBI D. Chew •Research: Canadian Institute of Health Research, Heart and Stroke Foundation of Canada