Stylet-Driven Lead Vs. Lumenless Lead for Left Bundle Branch Area Pacing: Systematic Literature Review and...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) enhances cardiac synchrony compared to conventional ventricular pacing.
• Lumenless pacing leads (LLLs) are commonly used for LBBAP, but stylet-driven pacing leads (SDLs) are an alternative.
• This study systematically reviews and meta-analyzes the literature comparing LLLs and SDLs for LBBAP.

Purpose of the Study:

• To compare the efficacy and safety of SDLs versus LLLs for LBBAP.
• To evaluate implantation success rates and procedural outcomes between the two lead types.
• To assess electrophysiological characteristics associated with LBBAP using SDLs and LLLs.

Main Methods:

• A systematic review and meta-analysis of full-text articles comparing LLLs and SDLs for LBBAP.
• Searched PubMed, Embase, and Cochrane Library databases up to April 9, 2024.
• Analyzed electrophysiological characteristics and procedural outcomes from 7 eligible studies.

Main Results:

• Implantation success rates for SDLs in LBBAP were non-inferior to LLLs (89% vs. 94%).
• No significant differences were observed in paced QRS duration or stimulus-to-left-ventricular activation time between SDLs and LLLs.
• Follow-up pacing parameters remained stable in both groups, indicating comparable long-term performance.

Conclusions:

• LBBAP using SDLs is a viable alternative to LLLs, demonstrating non-inferior implantation success.
• Procedural and electrophysiological characteristics are similar between SDLs and LLLs for LBBAP.
• This finding supports the use of SDLs in LBBAP, offering flexibility in lead choice.