Feasibility and Safety on Left Bundle Branch Area Pacing With Standard Stylet-Driven Lead: ACHIEVE-SYNC Multicenter Prospective Observational Cohort Study.

Background: Right ventricular pacing increases the risk of dyssynchrony, which raises the need for more physiological pacing strategies. Left bundle branch area pacing (LBBAP) has emerged, with most early studies utilizing lumen-less pacing leads. The feasibility and safety of LBBAP using conventional stylet-driven pacing lead (SDL) have been reported. We present prospective multicenter data, particularly in Asian clinical settings. Methods: The ACHIEVE-SYNC pilot study was a multicenter prospective observational cohort study conducted across several tertiary hospitals in South Korea. Patients with standard indications for pacemaker implantation underwent LBBAP using a 5.6Fr SDL with an extendable screw. Procedural success rate and LBBAP-related complications were evaluated. Pacing parameters, electrocardiographic features, and echocardiographic outcomes were assessed up to 12 months after implantation. Results: LBBAP using SDL was successful in 100 of 101 (99.0%) patients. LBBAP lead-related adverse event occurred in 1 case (0.99%), which was lead dislodgement. The median pacing threshold at 12-month follow-up was 0.8 [0.7-1.0] V at 0.5 ms. At 12-month follow-up, the mean QRS duration changed from 119.2 ± 28.6 ms to 131.2 ± 23.8 ms. The mean left ventricular ejection fraction was 61.3% ± 8.5% before the procedure and 61.3% ± 7.5% at 12-month follow-up. Conclusions: In this prospective multicenter registry, LBBAP using SDL demonstrated a near-complete procedural success rate and a high incidence of confirmed Left bundle branch capture. Lead performance remained stable during long-term follow-up, and adverse events were rare, supporting the safety and technical feasibility of this approach in routine clinical practice.