Safety and Efficacy of Stylet-Driven Leads for Left Bundle Branch Area Pacing in Octogenarians

Left bundle branch area pacing (LBBAP) is emerging as a physiological alternative to conventional pacing, particularly in elderly patients. Stylet-driven leads (SDL) offer unique procedural advantages, but data on their safety and efficacy in octogenarians remain sparse.

This study evaluates the feasibility, safety, and outcomes of SDL for LBBAP in octogenarians.

A retrospective, single-center study included 117 octogenarian patients (≥80 years) and 308 younger patients (<80 years) who underwent LBBAP with SDL between May 2022 and December 2023. Baseline characteristics, procedural success, and follow-up outcomes were analyzed. Complication rates and pacing parameters were assessed over 12 months.

Procedural success was high in both groups (93.2% in octogenarians vs. 96.1% in younger patients). Octogenarians had slightly longer fluoroscopy times (13.2 ± 1.4 vs. 11.8 ± 1.6 min, p = 0.031) and higher pacing thresholds at implantation (1.03 ± 0.56 V vs. 0.82 ± 0.42 V, p = 0.001). At 12 months, event-free survival was 91.4% in octogenarians and 94.8% in younger patients (p = 0.288). The overall complication rate was low (5.1% vs. 3.6%, p = 0.957), and no significant differences in pacing parameters were observed between groups. Improvements in left ventricular ejection fraction (LVEF) and QRS duration were consistent across both cohorts.

SDLs are safe and effective for LBBAP in octogenarians, providing high procedural success and significant clinical improvements. These findings highlight the potential of SDL as a viable option for elderly patients requiring physiological pacing, addressing the unique challenges posed by advanced age.