Key result
Stylet-driven LBBAP achieves ~87% success with stable long-term electrical performance and safety.
Why the study?
LBBAP has predominantly been performed using lumen-less leads, leaving the efficacy and safety of stylet-driven leads via SSPC sheaths to be explored.
Does left bundle branch area pacing with stylet-driven leads provide effective and safe pacing in patients with bradycardia indications?
Observational (n=79)
No
Does left bundle branch area pacing with stylet-driven leads provide effective and safe pacing in patients with bradycardia indications?
Left bundle branch area pacing using stylet-driven leads via site-selective pacing catheter sheaths is feasible and safe, achieving an 87.3% success rate with stable long-term electrical performance.
Supports LBBAP feasibility with stylet-driven leads in small series; leaves open randomized comparisons to lumen-less leads.
Background Left bundle branch area pacing (LBBAP) has emerged as a physiological pacing strategy. LBBAP has been predominantly performed using the lumen-less lead. Objectives This study aims to explore the efficacy and safety of LBBAP performed with stylet-driven leads (SDL) via site-selective pacing catheter (SSPC) sheaths. Methods We evaluated consecutive 79 patients undergoing LBBAP using standard stylet-driven active leads via SSPC sheaths. Pacing parameters (threshold, R-wave amplitude, impedance), QRS morphology and duration, left ventricular activation time in lead V5 and complication rates were analyzed. Postoperative measurements of lead parameters and complications were recorded at 1, 3, 6, and 12 months. Results LBBAP was successfully achieved in 69 of the 79 patients (87.3%), with 7742 leads via SSPC sheaths, with 52 patients (65.8%) showing visible left bundle branch potentials. Mean paced QRS duration and left ventricular activation time in lead V5 were 111.1 ± 27.2 ms and 69.0 ± 11.7 ms. Intraoperative electrode parameters for SDL-LBBAP, including pacing threshold (0.8 ± 0.2 V at 0.4 ms), impedance (792.5 ± 140.7 ohms), and sensing amplitude (14.0 ± 5.9 mV), remained stable during the 12 month follow up. Intraoperative ventricular septal perforation occurred in six patients (7.6%), with no subsequent persistent ventricular septal defects. Procedural time and fluoroscopy exposure time were lower in the latter 39 patients, declining markedly as operator experience accumulated. Conclusions The application of SDL in LBBAP is safe and feasible, with excellent success rates and stable long term electrical performance.
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Liang et al. (2026) conducted an observational in Bradycardia (n=79). Left bundle branch area pacing (LBBAP) with stylet-driven leads (SDL) was evaluated on Successful LBBAP (achievement of selective-LBBAP, non-selective LBBAP, or stable left ventricular septal pacing with satisfactory pacing parameters). Left bundle branch area pacing using stylet-driven leads was successfully achieved in 87.3% of patients, demonstrating stable long-term electrical performance and safety.
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