Key result
Stylet-driven leads yield similar implant success rates to lumen-less leads for LBBAP.
Why the study?
Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads, and the safety and feasibility of LBBAP using stylet-driven leads had not been explored in a multicenter population.
Does left bundle branch area pacing using stylet-driven leads provide comparable safety and feasibility to lumen-less leads in patients requiring anti-bradycardia pacing or heart failure therapy?
Cohort (n=412)
Yes
Does left bundle branch area pacing using stylet-driven leads provide comparable safety and feasibility to lumen-less leads in patients requiring anti-bradycardia pacing or heart failure therapy?
Absolute Event Rate: 94% vs 88%
p-value: p=0.058
Left bundle branch area pacing using stylet-driven leads is safe and feasible, achieving high implant success rates and stable pacing thresholds comparable to traditional lumen-less leads.
Supports SDL feasibility for LBBAP; leaves open randomized trials on long-term outcomes versus LLL.
Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads (LLL) with fixed helix design. This study is the first to explore in a multicenter population the safety and feasibility of LBBAP using stylet-driven leads (SDL) with extendable helix design. Methods This study prospectively enrolled all consecutive patients who underwent LBBAP for anti-bradycardia pacing or heart failure indications at 8 Belgian hospitals. LBBAP was attempted either using SDL or LLL delivered through dedicated delivery sheaths. Implant success, complications, procedural and pacing characteristics were recorded at implant and follow-up. Results The study enrolled 412 patients (mean age 74 ± 38 years, 44% female). LBBAP with SDL and LLL was successful in 334/353 (94%) and 52/59 (88%) respectively (p=0.058). Implant success for LBBAP using SDL varied from 93 to 100% among centers. Mean paced QRS duration and stimulus to left ventricular activation time were comparable for SDL and LLL (126 ± 21ms versus 125 ± 22ms, p=0.861 and 74 ± 17 and 75 ± 21ms, p=0.756). SDL LBBAP resulted in low pacing thresholds (0.6 ± 0.4V at 0.4ms), which remained stable at 1, 6 and 12 months of follow-up. Lead revisions for SDL LBBAP occurred in 5(1.4%) patients: 2 dislodgements at day 1, 1 late septal perforation at week 3, 1 Twiddler’s syndrome at 5 months, 1 lead fracture at 6 months. Conclusion This multicenter study confirms the safety and feasibility of LBBAP using SDL, which is characterized by high implant success, low complication rate and low and stable pacing thresholds.
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Pooter et al. (2022) conducted a cohort in Anti-bradycardia pacing or heart failure indications (n=412). Left bundle branch area pacing using stylet-driven leads vs. Lumen-less pacing leads was evaluated on Implant success (p=0.058). Left bundle branch area pacing using stylet-driven leads achieved a 94% implant success rate compared to 88% with lumen-less leads (p=0.058), with low and stable pacing thresholds.
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