Acute performance of stylet driven leads for left bundle branch area pacing: A comparison with lumenless leads

Abstract

BackgroundLumen-less leads (LLLs) are widely used for left bundle branch area pacing (LBBAP). Recently, stylet driven leads (SDLs) have also been used for LBBAP. ObjectiveWe sought to evaluate the acute performance of SDLs during LBBAP in comparison with LLLs. MethodsConsecutive patients undergoing LBBAP for bradycardia or CRT indications at 2 high-volume, early CSP adopters, tertiary centres were included from January 2019 to July 2023. Patients received either SDLs or LLLs at the implanting physician discretion. Acute performance and follow-up data of both lead types were evaluated. Results925 LBBAP implants were included, 655 using LLLs and 270 using SDLs. Overall, LBBAP acute success was significantly higher with LLLs (95.3% vs. 85.1% for SDL, p<0.001) even after the learning curve (97% vs 86%, p=0.013). LLLs were implanted in more mid-basal septal positions in comparison with SDLs, which tended to be implanted in more inferior and mid-apical septal positions. Acute lead related complications were higher with SDLs (15.9% vs 6.1%, respectively, p<0.001) with 15 cases of lead damage during implant (4.4% for SDLs vs. 0.5% for LLLs, p<0.001), although decreased with acquired experience and were comparable in the last 100 patients included in each group. Lead implant and fluoroscopy times were shorter for SDLs with lead dislodgment occurring in 0.9% with LLLs and 1.5% with SDLs, p=0.489. ConclusionsAcute lead performance proved to be different between LLLs and SDLs. A specific learning curve should be considered for SDLs even for implanters with large previous experience with LLLs.