Conduction System Pacing With Stylet Driven Leads: A Step-By-Step Guide to Implant
Ryan Burris1, Amulya Gampa1, Gaurav A Upadhyay1
1The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA.
Journal of Cardiovascular Electrophysiology
|August 14, 2025
Summary
Left bundle branch area pacing (LBBAP) using stylet-driven leads is a viable option for conduction system pacing (CSP). This technique offers a practical approach with potential for shorter procedure times and improved success rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Conduction system pacing (CSP) is gaining interest, with left bundle branch area pacing (LBBAP) emerging as a preferred method.
- LBBAP offers favorable pacing thresholds and perceived ease of implantation.
- Initial LBBAP techniques primarily used lumenless pacing leads.
Purpose of the Study:
- To provide a practical guide for LBBAP using stylet-driven leads.
- To highlight procedural nuances and tips for successful implantation.
- To discuss the increasing utilization of stylet-driven leads in CSP.
Main Methods:
- A step-by-step approach to LBBAP with stylet-driven leads is described.
- Focus on specific equipment (Boston Scientific Ingevity+ lead, SSPC sheaths) with mention of alternatives (Abbott, Biotronik).
- Key procedural steps include preprocedural planning, vascular access, sheath selection, ventriculography, lead delivery, and troubleshooting.
Main Results:
- Stylet-driven leads are demonstrated as a feasible option for LBBAP.
- The technique shares similarities with lumenless lead implantation.
- Key differences in technique are learnable and can enhance success.
Conclusions:
- Stylet-driven leads are a practical alternative for left bundle branch area pacing.
- Mastering specific procedural differences can improve implantation success rates.
- This approach offers a valuable option for conduction system pacing.
