Initial experience with stylet‐driven versus lumenless lead delivery systems for left bundle branch area pacing

Abstract

Introduction: Left bundle branch area pacing (LBBP) has emerged as an alternative method for conduction system pacing. While initial experience with delivery systems for stylet-driven and lumenless lead implantation for LBBP has been described, data comparing outcomes of stylet-driven versus lumenless lead implantation for LBBP are limited. In this study, we compare success rates and outcomes of LBBP with stylet-driven versus lumenless lead delivery systems.Methods: Eighty-three consecutive patients (mean age 74.1 ± 11.2 years; 56 [68%] male) undergoing attempted LBBP at a single institution were identified. Cases were grouped by lead delivery systems used: stylet-driven (n = 53) or lumenless (n = 30).Baseline characteristics and procedural findings were recorded and compared between the cohorts. Intermediate term follow-up data on ventricular lead parameters were also compared.Results: Baseline characteristics were similar between groups. Successful LBBP was achieved in 77% of patients, with similar success rates between groups (76% in stylet-driven, 80% in lumenless, p = 0.79), and rates of adjudicated LBB capture and other paced QRS parameters were also similar. Compared with the lumenless group, the stylet-driven group had significantly shorter procedure times (90 ± 4 vs. 112 ± 31 min, p = 0.004) and fluoroscopy times (10 ± 5 vs. 15 ± 6 min, p = 0.003).Ventricular lead parameters at follow-up were similar, and rates of procedural complications and need for lead revision were low in both groups. Conclusion:Delivery systems for stylet-driven and for lumenless leads for LBBP have comparable acute success rates. Long-term follow-up of lead performance following use of the various delivery systems is warranted.

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

“…The fact that continuous pacing while screwing the lead is easily possible with SDLs as well as the higher torque and push associated with the larger lead diameter and the use of an inserted stylet may explain the reduction in implant time. These findings were also previously described by Braunstein et al 16 and may reflect some of the most important features regarding the use of SDLs for CSP, which are the higher penetration power within the septum related to a higher sheath stiffness, the larger lead body diameter, and the presence of an inner lumen with an stylet, all of them providing more power during lead penetration. However, in our series, this did not translate into a lower number of lead penetration attempts for SDLs and probably reflects that these same features make more difficult the appropriate sheath and lead alignment toward the septum and also lead stability during penetration.…”

Result of the left bundle branch area pacing data collection registry, an international multicenter study of conduction system pacing with a Tendril STS 2088 stylet‐driven lead

“…While Braunstein et al 21 reported a success rate of 76% with styletdriven leads early in their experience, subsequent studies have reported high success rates of 94% (93%-100% among centers) as in a multicenter observational study of stylet-driven leads. 22 The primary composite effectiveness endpoint of capture threshold of ≤2.0 V and sensing amplitudes of ≥5.0 mV (or ≥value at implant) was achieved in 93% of patients at 6-month follow-up.…”

“…In previous studies, the success rate for LBBAP has varied from 76% to 97.8% for LBBAP. [7][8][9][20][21][22][23] In their initial experience of LBBAP, Vijayaraman et al 7 reported an overall success rate of 93% in a prospective series of 100 patients. Su et al 9 reported a success rate of 97.8% for LBBAP in a single-center, prospective series of 632 patients over a 2-year period after excluding their initial learning curve of 30 patients.…”

“…These results were comparable to previous reports of lead performance in the LBBA. [7][8][9][20][21][22][23] Prior studies have demonstrated a long learning curve for HBP to achieve acceptably high success rates. Our registry data confirms that high success rates were achieved with LBBAP despite lack of operator experience unlike HBP where prior experience was a determinant of successful implantation.…”

“…With recent introduction of various delivery sheaths to guide septal implantation, both stylet-driven and nonstyletdriven leads are now utilized clinically to achieve LBBAP. [20][21][22][23] The LBBAP data collection registry is an international, multicenter, observational registry of patients with attempted implants of the Tendril™ STS 2088 lead in the LBBA and then followed for at least 6 months post the implant attempt.…”