PO-03-025 LUMENLESS VERSUS STYLET-DRIVEN LEADS FOR LEFT BUNDLE BRANCH AREA PACING: EVALUATING OUTCOMES IN SHORT-TERM FOLLOW-UP

Abstract

Although left bundle branch area pacing (LBBAP) may be performed with lumenless or stylet-driven leads, there remains a relative paucity of data comparing outcomes between the two approaches. We sought to evaluate implant success, capture thresholds, and safety among patients undergoing CSP with lumenless leads (LL) or stylet-driven leads (SDL). Patients undergoing LBBAP with SDL or LL between May 2018 to August 2022 were studied at a single center. Baseline pacing parameters and follow-up capture thresholds were assessed. LBBAP lead-associated complications were assessed with chart review. LBBAP was pursued in 166 patients, in whom implant success was achieved in 152 (92%) and the remainder received right ventricular septal pacing (RVS). LL leads (Medtronic SelectSecure 3830) were delivered in 96 patients, and 70 received SDL (57 Boston Scientific Ingevity, 13 Biotronik Solia). Of these, 21 (13%) were for CRT systems. Failure to achieve LBBAP occurred in 5 (5.2%) LL patients and 5 (8.8%) SDL patients. Average age was 76 years, 48% female, 60% African American, 81% with hypertension, 21% with cardiomyopathy, and 38% with history of atrial fibrillation or atrial flutter. At baseline capture threshold was 0.61 ± 0.23 V and 0.45 ±0.12 ms for SDL and 0.56 ± 0.23 V and 0.43 ± 0.76 ms in LL (p=0.16 for V and p=0.12 for ms). At 3 months, capture threshold was slightly higher for SDL (0.96±0.51 V and 0.44±0.13 ms) versus LL (0.84 ± 0.44 V and 0.42 ± .08 ms) (p=0.15 for V and p=0.29 for ms). Overall average follow-up time was 11.2 ± 10.4 months for LL and 8.6 ± 6.9 months for SDL. At last follow-up, capture thresholds were comparable: SDL 0.99 ± 0.50 V and 0.44 ± 0.13 ms versus 0.95 ± 0.63 V and 0.43 ± 0.10 ms for LL (see FIGURE). There were 3 (1.9%) LBBAP-associated lead macro-dislodgements, with 2 occurring in LL patients (both occurring during system revisions) and 1 SDL patient (within 24 hours of implant). Capture thresholds for LBBAP show a nonsignificant rise in short-term follow-up for stylet-driven leads versus lumenless leads, and this attenuated further in mid-term follow-up. Safety appears comparable between the two lead types.