Comparing Efficacy and Complications Between Stylet‐Driven Leads and Lumenless Leads in Left Bundle Branch Area Pacing

BACKGROUND: Left bundle branch area pacing (LBBAP) is an emerging technique in conduction system pacing (CSP) that may offer improved outcomes over traditional methods. Typically, lumenless leads are used; however, stylet-driven leads have recently been considered. This study conducts a systematic review and meta-analysis evaluating the efficacy and complications of stylet-driven leads versus lumenless leads. METHOD: Databases including PubMed, Embase, and Scopus were searched from inception to June 2024 for relevant studies. We included published prospective or retrospective randomized controlled trials and cohort studies using stylet-driven leads or lumenless leads for LBBAP. Data were combined using a random-effects, generic inverse variance method of DerSimonian and Laird. RESULTS: Sixty-eight studies involving 8996 patients from 2016 to 2023 were included. From eight head-to-head studies, the stylet-driven leads group had a comparable success rate (OR = 1.46, 95% CI: 0.89, 2.39) but showed shorter procedural time (weighted mean difference [WMD] = -16.82 min, 95% CI: -24.42, -9.21). Stylet-driven leads had a higher pacing threshold at implantation (WMD = 0.09 V, 95% CI: 0.00, 0.17) and lower lead impedance (WMD = -86.13 ohms, 95% CI: -129.46, -42.80). QRS duration and R wave amplitude were comparable initially, but at follow-up (1-12 months), stylet-driven leads had a lower R wave amplitude (WMD = -1.92 mV, 95% CI: -3.33, -0.51). Complication rates were higher with stylet-driven leads (OR = 1.80, 95% CI: 1.34, 2.41), particularly lead dislodgement (OR = 3.26, 95% CI: 1.75, 6.07) and helix damage (OR = 11.46, 95% CI: 3.58, 36.63). CONCLUSION: In this meta-analysis of 8996 patients, stylet-driven leads for LBBAP showed a comparable success rate to lumenless leads but was associated with a higher complication risk.