The Zwolle experience with left bundle branch area pacing using stylet-driven active fixation leads.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique.
• It is considered a promising alternative to His bundle pacing.
• Current LBBAP often utilizes lumen-less pacing leads with fixed helix designs.

Purpose of the Study:

• To compare the performance of lumen-less leads (LLL) versus stylet-driven active fixation leads (SDL) for LBBAP.
• The study evaluated lead parameters, procedural success, and complication rates.

Main Methods:

• A prospective study enrolled patients undergoing LBBAP at Isala Hospital.
• Implanters chose between LLL (Medtronic 3830) and SDL (Abbott 2088TC-38) for the LBBAP lead.
• Most patients also received a standard right ventricular lead as backup.

Main Results:

• The study included 94 patients with a mean follow-up of 30 weeks.
• Procedural success rates were 90.3% for LLL and 96.8% for SDL (P=0.199).
• SDL required significantly fewer deployments (2 vs. 4, P=0.005) with comparable implantation times and low pacing thresholds.

Conclusions:

• LBBAP using SDL is feasible and effective.
• SDL offers comparable success rates to LLL with a reduced number of active fixation screw deployments.
• This suggests SDL may be a more efficient option for LBBAP procedures.