March 27, 2025Journal of Cardiovascular ElectrophysiologyOpen Access

Comparison of Clinical Outcomes Between Left Bundle Branch Area Pacing With a Stylet‐Driven Lead and Conventional Right Ventricular Pacing

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Pacemaker implantation requiring substantial ventricular pacing (n=738). Intervention: Left bundle branch area pacing (LBBAP) with a stylet-driven lead vs. Conventional right ventricular pacing (RVP). Primary outcome: Composite outcome I (HF admission, pacing-induced cardiomyopathy, and upgrade to biventricular pacing) (adjusted HR 0.27, 95% CI 0.11-0.68, p=0.006).

Q: What does this research mean for the field?

Left bundle branch area pacing using a stylet-driven lead is associated with a significantly lower risk of adverse composite heart failure outcomes compared to conventional right ventricular pacing in patients requiring substantial ventricular pacing. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Stylet-driven LBBAP linked to ~73% lower risk of composite HF outcomes versus conventional RVP.

adjusted HR 0.27
95% CI 0.11-0.68
P=0.006
n=738

Why the study?

Limited data exist comparing clinical outcomes of left bundle branch area pacing using stylet-driven leads versus conventional right ventricular pacing.

Does left bundle branch area pacing with a stylet-driven lead reduce adverse clinical outcomes compared to conventional right ventricular pacing in patients requiring substantial ventricular pacing?

Population

738 patients undergoing pacemaker implantation at two tertiary hospitals from December 2018 to December 2023

Comparison

Left bundle branch area pacing with stylet-driven lead vs conventional right ventricular pacing

Design

Observational cohort study

Authors

KLKyung‐Yeon LeeSeoul National University Hospital JPJinsun ParkPusan National University JCJungMin ChoiSeoul National University Hospital

Discussion

Member takes

Implication

May favor stylet-driven LBBAP in pacing-dependent patients; leaves open confirmation in randomized trials.

Study Design

Type

Cohort (n=738)

Multicenter

Yes

Structured PICO

Does left bundle branch area pacing with a stylet-driven lead reduce adverse clinical outcomes compared to conventional right ventricular pacing in patients requiring substantial ventricular pacing?

Population

738 patients (mean age 72.1 years, 48% female) undergoing pacemaker implantation with ventricular pacing burden >10%, excluding those requiring cardiac resynchronization therapy.

Exposure

Left bundle branch area pacing (LBBAP) using stylet-driven leads (SDL) with a fixed curve delivery sheath (n=243)

Comparator

Conventional right ventricular pacing (RVP) (n=495)

Outcome

Composite outcome I (heart failure admission, pacing-induced cardiomyopathy defined as an LVEF decline of ≥ 10% or below 50%, and upgrade to biventricular pacing) and Composite outcome II (all-cause death in addition to the components of composite outcome I)composite

Main Result

Hazard Ratio: 0.27 (95% CI 0.11–0.68)

p-value: p=0.006

Left bundle branch area pacing using stylet-driven leads significantly reduces the risk of pacing-induced cardiomyopathy and heart failure events compared to conventional right ventricular pacing in patients requiring substantial ventricular pacing.

Cite This Study

Lee et al. (2025) conducted a cohort in Pacemaker implantation requiring substantial ventricular pacing (n=738). Left bundle branch area pacing (LBBAP) with a stylet-driven lead vs. Conventional right ventricular pacing (RVP) was evaluated on Composite outcome I (HF admission, pacing-induced cardiomyopathy, and upgrade to biventricular pacing) (adjusted HR 0.27, 95% CI 0.11-0.68, p=0.006). Left bundle branch area pacing with a stylet-driven lead was associated with a lower risk of composite HF outcomes compared to conventional RVP (adjusted HR 0.27; 95% CI 0.11-0.68; p=0.006).

synapsesocial.com/papers/6aaf673b1512dcc6655d2b9b https://doi.org/10.1111/jce.16648

Topics

Heart failure HFrEF treatment Cardiomyopathy

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Comparison of Clinical Outcomes Between Left Bundle Branch Area Pacing With a Stylet‐Driven Lead and Conventional Right Ventricular Pacing

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Comparison of Clinical Outcomes Between Left Bundle Branch Area Pacing With a Stylet‐Driven Lead and Conventional Right Ventricular Pacing

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider