Key result
Left bundle branch area pacing using stylet-driven leads yielded a comparable implant success rate to lumen-less leads (87% vs 89%, p=0.834).
Why the study?
LBBAP had exclusively been performed using lumen-less pacing leads with fixed helix design, leaving the feasibility and safety of stylet-driven leads with an extendable helix unexplored.
Does left bundle branch area pacing using stylet-driven leads provide comparable implant success and pacing thresholds to lumen-less leads in patients requiring pacing for bradycardia or heart failure?
Cohort (n=50)
No
Does left bundle branch area pacing using stylet-driven leads provide comparable implant success and pacing thresholds to lumen-less leads in patients requiring pacing for bradycardia or heart failure?
Stylet-driven leads with an extendable helix are a feasible and safe alternative to lumen-less leads for left bundle branch area pacing, yielding comparable success rates and pacing thresholds.
Answers are grounded in this paper and cite their sources.
Supports stylet-driven leads as feasible LBBAP option in observational data; leaves open need for RCTs on long-term thresholds and outcomes.
Introduction Left bundle branch area pacing (LBBAP) aims to achieve physiological pacing by capturing the conduction system in the area of the left bundle branch. LBBAP has exclusively been performed using lumen-less pacing leads (LLL) with fixed helix design. This study explores the feasibility, safety and pacing characteristics of LBBAP using stylet-driven leads (SDL) with an extendable helix design. Methods Patients, in which LBBAP was attempted for bradycardia or heart failure pacing indications, were prospectively enrolled at the Ghent University Hospital. LBBAP was attempted with two different systems: 1/ LLL with fixed helix (SelectSecure 3830, Medtronic, Inc) delivered through a preshaped sheath (C315His Medtronic) and 2/ SDL with extendable helix (SoliaS60, Biotronik, SE & CO) delivered through a new delivery sheath (Selectra 3D, Biotronik). Results The study enrolled 50 patients (mean age 7014 years, 44% female). LBBAP with SDL was successful in 20/23 (87%) patients compared to 24/27 (89%) of patients in the LLL group (p=0.834). Screw attempts, screw implant depth, procedural and fluoroscopy times were comparable among both groups. Acute LBBAP thresholds were low and comparable between SDL and LLL (0.50.15V versus 0.40.17V, p=0.251). Pacing thresholds remained low at 32.1 months of follow up in both groups and no lead revisions were necessary. Post procedural echocardiography revealed a septal coronary artery fistula in one patient with SDL LBBAP. Conclusion LBBAP using stylet-driven pacing leads is feasible and yields comparable implant success to LBBAP with lumen-less pacing leads. LBBAP thresholds are low and comparable with both types of leads.
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Pooter et al. (2020) conducted a cohort in Bradycardia or heart failure pacing indications (n=50). Stylet-driven leads (SDL) with extendable helix vs. Lumen-less pacing leads (LLL) with fixed helix was evaluated on LBBAP implant success (p=0.834). Left bundle branch area pacing using stylet-driven leads yielded a comparable implant success rate to lumen-less leads (87% vs 89%, p=0.834).
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