Left bundle branch area pacing using stylet‐driven pacing leads with a new delivery sheath: A comparison with lumen‐less leads

Abstract

Introduction Left bundle branch area pacing (LBBAP) aims to achieve physiological pacing by capturing the conduction system in the area of the left bundle branch. LBBAP has exclusively been performed using lumen‐less pacing leads (LLLs) with fixed helix design. This study explores the feasibility, safety, and pacing characteristics of LBBAP using stylet‐driven leads (SDLs) with an extendable helix design. Methods Patients, in which LBBAP was attempted for bradycardia or heart failure pacing indications, were prospectively enrolled at the Ghent University Hospital. LBBAP was attempted with two different systems: 1/LLL with fixed helix (SelectSecure 3830, Medtronic Inc.) delivered through a preshaped sheath (C315His Medtronic Inc.) and 2/SDL with extendable helix (Solia S60, Biotronik, SE & CO) delivered through a new delivery sheath (Selectra 3D, Biotronik). Results The study enrolled 50 patients (mean age: 70 ± 14 years, 44% females). LBBAP with SDL was successful in 20/23 (87%) patients compared with 24/27 (89%) of patients in the LLL group (p = 0.834). Screw attempts, screw implant depth, procedural, and fluoroscopy times were comparable among both groups. Acute LBBAP thresholds were low and comparable between SDL and LLL (0.5 ± 0.15 V vs. 0.4 ± 0.17 V, p = 0.251). Pacing thresholds remained low at 3 ± 2.1 months of follow up in both groups and no lead revisions were necessary. Postprocedural echocardiography revealed a septal coronary artery fistula in one patient with SDLLBBAP. Conclusion LBBAP using stylet‐driven pacing leads is feasible and yields comparable implant success to LBBAP with LLLs. LBBAP thresholds are low and comparable with both types of leads.

First report of super-response after left bundle branch area pacing for cardiac resynchronization therapy utilizing a stylet-driven lead

“…On the other hand, stylet driven leads have a smaller helix relative to the lead body. With that noted, multiple operators have noted the stylet provides additional and stiffer support to allow for penetration into the septum 10 and avoid the risk of RV septal entanglement as has been noted in prior cadaveric study of the 3830. 12 An additional advantage of the stylet-driven leads are the opportunity to assess real-time changes in QRS morphology and impedance during J o u r n a l P r e -p r o o f 9 lead advancement (by attaching sensing cables to the exposed stylet in a unipolar fashion).…”

A Guide to Left Bundle Branch Area Pacing Using Stylet-Driven Pacing Leads

“…Reported experience with LBBAP using SDL is limited ( 11 , 12 ). In a recent study, SDL- and LLL-LBBAP yielded similar implant success rates, procedural safety and pacing characteristics ( 11 ).…”

“…Given the length of SDL helix, extending the helix alone will not penetrate the septum deep enough to achieve LBBAP. Therefore, similar to LLL-LBBAP, rotating the outer lead body of SDL is mandatory to access deep septal position ( 11 , 12 ). However, when rotating the outer lead body of SDL, retraction of the helix may occur due to fixation in the tissue causing the outer coil to turn over the inner coil.…”

“…Detailed operator guides on how to perform LBBAP using LLL (LLL-LBBAP) have been previously published ( 10 ). Recently, LBBAP using standard stylet-driven pacing leads (SDL) has been reported to be safe and feasible ( 11 , 12 ). However, due to the differences in lead and helix design, LBBAP with SDL (SDL-LBBAP) requires different handling and lead preparation.…”

Left bundle branch pacing: An evolving site for physiological pacing

“… 7 Another implantation system used is stylet‐driven leads with an extendable helix design (Solia S60, Biotronik, SE & CO) delivered through a new delivery sheath (Selectra 3D, Biotronik). 20 Unlike HBP, which has a narrow target, LBBP has a larger target area, however, it is located on the left side of the septum. Because the procedures are performed on the right side of the septum, there are no definite potentials to target at first.…”