Caveats related to conduction system pacing utilizing a proprietary deflectable mapping catheter with a stylet-driven...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Lumenless leads (LLLs) were standard for conduction system pacing (CSP).
• This study presents the largest experience using stylet-driven leads (SDLs) with a deflectable mapping catheter for CSP.

Purpose of the Study:

• To evaluate the safety, feasibility, and efficacy of CSP using SDLs with a deflectable mapping catheter.
• To report procedural success rates and intermediate-term follow-up outcomes.

Main Methods:

• Prospective, sequential enrollment of patients for CSP using SDLs.
• Comparison between a novel deflectable mapping catheter (Group A) and a fixed curve sheath (Group B) in a 1:1 non-randomized fashion.
• Default strategy in Group A was His bundle pacing (HBP) with left bundle branch area pacing (LBBaP) as bailout.

Main Results:

• Seventy-nine patients were enrolled; 40 in Group A and 39 in Group B.
• In Group A, HBP succeeded in 42.5% of patients, with 57.5% requiring LBBaP bailout.
• A manual septal curve aided LBBaP in 26.1% of bailout cases; procedural and follow-up parameters did not differ significantly between HBP and LBBaP.

Conclusions:

• SDLs with a single-curve deflectable mapping catheter are safe and feasible for CSP.
• Moderate procedural success was achieved with HBP, but LBBaP bailout was frequently necessary.
• Optimization of LBBaP in approximately one-fourth of bailout cases required an out-of-plane manual septal curve.