Left bundle branch area pacing using stylet-driven pacing leads as
compared to 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 (LLL) with fixed helix design. This study
explores the feasibility, safety and pacing characteristics of LBBAP
using stylet-driven leads (SDL) 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) and 2/ SDL with extendable helix
(SoliaS60, Biotronik, SE & CO) delivered through a new delivery sheath
(Selectra 3D, Biotronik). Results The study enrolled 50 patients (mean
age 7014 years, 44% female). LBBAP with SDL was successful in 20/23
(87%) patients compared to 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 (0.50.15V versus
0.40.17V, p=0.251). Pacing thresholds remained low at 32.1 months of
follow up in both groups and no lead revisions were necessary. Post
procedural echocardiography revealed a septal coronary artery fistula in
one patient with SDL LBBAP. Conclusion LBBAP using stylet-driven pacing
leads is feasible and yields comparable implant success to LBBAP with
lumen-less pacing leads. LBBAP thresholds are low and comparable with
both types of leads.