PO-03-014 LONG-TERM OUTCOMES OF CONDUCTION SYSTEM PACING IN LEFT VENTRICULAR DYSFUNCTION USING STYLET-DRIVEN LEADS: A COMPARISON WITH LUMEN-LESS LEADS

Abstract

Long-term outcomes of conduction system pacing (CSP) using stylet-driven leads (SDL) among patients with left ventricular systolic dysfunction (LVSD) have neither been studied nor been compared with lumen-less leads (LLL). The study’s objective was to compare stylet-driven (SDL) leads with lumen-less (LLL) in terms of feasibility, pacing characteristics, and long-term outcomes. Retrospective analysis of single-centre data of consecutive patients with LVEF < 50% undergoing a successful CSP implant using SDLs and LLLs between Jan 2020 to Aug 2022. Indications for CSP implant were Resynchronization therapy, bradycardia indication with LVEF < 50% with anticipated to require > 20% ventricular pacing and Pacing-induced Cardiomyopathy (PICMP). Among 114 patients (age 62.2 ± 11.3 years, 65 males) with LVEF < 50% (mean 29.2 ± 7.7%) undergoing CSP, LLLs and SDLs were used in 65 and 49 patients respectively. 9 LLL and 7 SDL implants used HBP; the remaining implants were LBBAP or LOT-CRT. CRT, bradyarrhythmia with LV dysfunction, and PICMP were the indications for CSP in 77, 32, and 5 patients, respectively. CRT indication (n = 70) was treated with LLL-LBBAP/LOT-CRT, SDL-LBBAP/LOT-CRT, LLL-HBP, and SDL-HBP, respectively. LLL-LBBAP/LOT-CRT, SDL-LBBAP/LOT-CRT, LLL-HBP, and SDL-HBP were used in 8, 13, 5, and 6 patients with bradyarrhythmia-CSP, respectively. At a median follow-up of 494 days (IQR: 208–636) for LLLs and 235 days (IQR: 122–333) for SDLs, LBBAP, unlike HBP, had similar lead parameters for both LLLs and SDLs with few complications. Four fatalities (three non-cardiac) occurred among the 112 patients accessible for follow-up. QRS narrowing (LLL: 168.8 ± 15.7 to 114.3 ± 16.5 ms, SDL: 166.3 ± 16.7 to 115.0 ± 14.2 ms), LVEF improvement (LLL: 26.7 ± 6 to 48.4 ± 8.0%, SDL: 25.7 ± 6.7 to 46.7 ± 8.0%), and NYHA class improvement (LLL: 2.8 ± 0.9 to 1.1 ± 0.3, SDL: 2.6 ± 0.8 to 1.2 ± 0.4) were similar between LLLs and SDLs for patients with LBBB undergoing LBBAP/LOT-CRT. Paced QRS duration (LLL:126.3 ± 14.2 ms, SDL:120.5 ± 7.5 ms) and LVEF stabilization (LLL:34.6 ± 6 to 40.1 ± 10.1%, SDL: 38.2 ± 7.5 to 45.8 ± 7%) was comparable across LLLs and SDLs for patients undergoing LBBAP/LOT-CRT for pacing. In this largest series of SDLs in LV dysfunction and the only direct comparison of SDLs vs. LLLs among patients with LVSD, both leads showed equal and good long-term performance when used for conduction system pacing.