Efficacy and safety of lumenless leads compared with stylet-driven leads for left bundle branch area pacing

Left Bundle Branch Area Pacing (LBBAP) was initially performed with lumenless leads (LLLs). In the last years, stylet-driven leads (SDLs) have emerged as an alternative. However, we are still lacking data comparing these two different approaches.

To compare the efficacy and safety of LLLs Vs SDLs for LBBAP.

116 patients who underwent LBBAP attempt in our institution were prospectively included (mean age 74 ± 9 years, 40 (34%) female). We recorded and analyzed baseline characteristics, procedural findings, LBB capture criteria, lead parameters, success rates and complications. A 6-month remote follow-up data was programmed in every patient.

We analyzed 75 patients who received LLLs and 41 patients with SDLs. Baseline characteristics were similar in both groups (table 1). There were no significant differences regarding Paced QRS (114 ± 18 ms Vs 117 ± 19 ms, p = 0.36), presence of a LB potential (16 (21%) Vs 9 (22%), p = 0.93), V6 R-wave peak time (V6RWPT) (83 ± 15 ms Vs 82 ± 16 ms, p = 0.71) or V6–V1 inter-peak interval (40 ± 17 ms Vs 37 ± 13 ms, p = 0.37). Time to lead implant was also similar (37 ± 18 minutes Vs 37 minutes ± 13 minutes, p = 0.87). Mean pacing voltage threshold was higher for SDLs after implantation (0.71 ± 0.33 V Vs 0.86 ± 0.30 V, p = 0.02) and also at the 6-month remote follow-up (0.75 ± 0.28 V Vs 0.9 ± 0.34 V, p = 0,04). R-wave amplitude and impedance were also higher in SDLs (table 1).

According to 2023 EHRA clinical consensus statement on conduction system pacing, we achieved confirmed LBBP in 63 patients (54%), likely LBBP in 30 patients (26%) and Left Ventricular Septal Pacing (LVSP) in 21 patients (18 %), with no differences between groups (table 1). After the 6-month follow-up, a higher probability of lead dislodgement was appreciated in the SDLs group (3 (7%) Vs 0 (0%), p = 0,01).

LLLs and SDLs are effective tools to perform LBBAP, achieving similar paced QRS and and success rates. SDLs were associated with slightly higher pacing threshold. After the 6-month follow-up, a higher probability of lead dislodgement was appreciated in the SDLs group.