Stylet-driven vs. non-stylet-driven lead implantation for left bundle branch area pacing

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Left bundle branch area pacing (LBBAP) is a novel pacing strategy, which overcomes limitations of right ventricular pacing. Conventional stylet-driven and non-stylet-driven leads have been used as a conduction system pacing lead. Procedural outcome data comparing both lead types are, however, scarce. PURPOSE: To compare procedural outcomes during CSP device implantation with respect to the use of stylet-driven vs. non-stylet-driven leads. METHODS: We prospectively assessed 170 consecutive LBBAP lead implantation attempts at our center from 09/2021 to 11/2022. All implanters had previous experience with His-bundle pacing lead implantation using the non-stylet-driven lead and 91% of all systems were implanted by two high-volume device implanters. Successful conduction system pacing was established according to standard criteria (LBBAP: R-wave peak time in V6, V1-V6-interpeak interval, programmed stimulation or visibility of a left bundle potential) and pacing thresholds (<2V/0.5ms). The used leads in this analysis were the non-stylet-driven 3830 SelectSure lead (Medtronic, US) and the stylet-driven Solia (Biotronik, Germany), Ingevity+ (Boston Scientific, US) and Tendril STS (Abbott, US) lead. Patient selection and implantation strategy was at the operator’s discretion. RESULTS: Clinical baseline characteristics, echocardiography/ECG data and indications did not differ between patients, who received a stylet-driven or non-stylet-driven lead (table showing percentages and median values/interquartile ranges). Patients underwent implantation of a non-stylet driven 3830 SelectSure lead in 20% of cases and a stylet-driven lead in 80% of cases (Solia 76%, Ingevity+ 3%, Tendril STS 1%). Electrical outcome data did not differ between lead types. However, procedural success rate was significantly higher using stylet-driven leads (p=0.025) and a trend towards shorter overall intervention duration was observed as well (p=0.1). CONCLUSION: Stylet-driven leads offer higher LBBAP lead implantation success rates while shortening implant duration. [Figure: see text]