Key result
Stylet-driven leads for LBBAP achieve similar success and LV synchrony compared to lumen-less leads.
Why the study?
LBBAP was previously only achievable with lumen-less leads, but stylet-driven leads have recently emerged and comparative data on left ventricular dyssynchrony were needed.
Does left bundle branch area pacing using stylet-driven leads maintain left ventricular synchrony compared to lumen-less leads in patients requiring pacing?
Cohort (n=97)
Does left bundle branch area pacing using stylet-driven leads maintain left ventricular synchrony compared to lumen-less leads in patients requiring pacing?
Stylet-driven leads provide comparable left ventricular electrical and mechanical synchrony to lumen-less leads in left bundle branch area pacing.
Answers are grounded in this paper and cite their sources.
Stylet-driven leads may expand LBBAP options; leaves open need for randomized confirmation of long-term equivalence.
Background: Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing method to reduce left ventricular (LV) dyssynchrony due to ventricular pacing. Only lumen-less pacing leads (LLLs) with fixed helixes could achieve LBBAP previously, but recently, LBBAP has been performed using stylet-driven leads (SDLs). This study aimed to evaluate the LV dyssynchrony between SDLs and LLLs techniques in LBBAP. Methods: We retrospectively evaluated patients who underwent LBBAP with either SDLs or LLLs. We compared both groups’ electrocardiogram (ECG) findings and LV dyssynchrony parameters derived from myocardial perfusion scintigraphy. LV dyssynchrony parameters consisted of phase analysis and regional wall motion analysis. We evaluated bandwidth, phase standard deviation (PSD), and entropy in the phase analysis. The time to the end-systolic frame (TES) was calculated in regional wall motion analysis using single-photon emission computed tomography (SPECT). We also evaluated the maximum differences between segmental TES (MDTES), the standard deviation of TES (SDTES), and the difference in the TES between the lateral wall and septum (DTES-LS). Results: In total, 97 patients were enrolled. The success rate of LBBAP did not differ between the groups [SDLs: 47/48 patients (98%) vs. LLLs: 47/51 patients (92%), P=0.36]. The paced QRS duration and the stimulus to the peak LV activation time (stim-LVAT) also did not differ between SDL and LLL groups (122±10 vs. 119±12 ms, P=0.206; 69±12 vs. 66±13 ms, P=0.31, respectively). There were no differences in bandwidth, PSD, and entropy between SDL and LLL groups (73°±37° vs. 86°±47°, P=0.18; 19°±8.5° vs. 21°±9.7°, P=0.19; 0.57±0.08 vs. 0.59±0.08, P=0.17, respectively). The regional wall motion analysis parameters MDTES, SDTES, and DTES-LS also did not differ between SDL and LLL groups (19%±10% vs. 20%±10%, P=0.885; 5.0%±2.5% vs. 5.0%±2.5%, P=0.995; 5.0%±3.7% vs. 4.8%±4.2%, P=0.78, respectively). Conclusions: LBBAP using SDLs was comparable to LV electrical and mechanical synchrony with LLLs.
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Miyajima et al. (2023) conducted a cohort in Left bundle branch area pacing (LBBAP) (n=97). Stylet-driven leads (SDLs) vs. Lumen-less leads (LLLs) was evaluated on Success rate of LBBAP (p=0.36). Left bundle branch area pacing using stylet-driven leads achieved a similar success rate and comparable left ventricular synchrony compared to lumen-less leads.
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