Initial experience with stylet-driven versus lumenless lead delivery systems for left bundle branch area pacing

• Published in: Journal of cardiovascular electrophysiology Vol. 34; no. 3; pp. 710 - 717
• Main Authors: Braunstein, Eric D, Kagan, Ruth D, Olshan, David S, Gabriels, James K, Thomas, George, Ip, James E, Markowitz, Steven M, Lerman, Bruce B, Liu, Christopher F, Cheung, Jim W
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2023
• Subjects: Aged; Aged, 80 and over; Bundle of His; Cardiac Conduction System Disease; Cardiac Pacing, Artificial - methods; Electrocardiography - methods; Female; Fluoroscopy; Heart Conduction System; Humans; Male; Middle Aged; Success; Ventricle; conduction system pacing; left bundle branch area pacing; LBBAP; LBBP
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.15789

Left bundle branch area pacing (LBBP) has emerged as an alternative method for conduction system pacing. While initial experience with delivery systems for stylet-driven and lumenless lead implantation for LBBP has been described, data comparing outcomes of stylet-driven versus lumenless lead implantation for LBBP are limited. In this study, we compare success rates and outcomes of LBBP with stylet-driven versus lumenless lead delivery systems.
Eighty-three consecutive patients (mean age 74.1 ± 11.2 years; 56 [68%] male) undergoing attempted LBBP at a single institution were identified. Cases were grouped by lead delivery systems used: stylet-driven (n = 53) or lumenless (n = 30). Baseline characteristics and procedural findings were recorded and compared between the cohorts. Intermediate term follow-up data on ventricular lead parameters were also compared.
Baseline characteristics were similar between groups. Successful LBBP was achieved in 77% of patients, with similar success rates between groups (76% in stylet-driven, 80% in lumenless, p = 0.79), and rates of adjudicated LBB capture and other paced QRS parameters were also similar. Compared with the lumenless group, the stylet-driven group had significantly shorter procedure times (90 ± 4 vs. 112 ± 31 min, p = 0.004) and fluoroscopy times (10 ± 5 vs. 15 ± 6 min, p = 0.003). Ventricular lead parameters at follow-up were similar, and rates of procedural complications and need for lead revision were low in both groups.
Delivery systems for stylet-driven and for lumenless leads for LBBP have comparable acute success rates. Long-term follow-up of lead performance following use of the various delivery systems is warranted.