Stylet-driven vs non-stylet-driven leads for conduction system pacing: Insights from the NCDR Electrophysiology...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Conduction system pacing (CSP), encompassing His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), is an emerging alternative to conventional ventricular pacing.
• The selection between stylet-driven leads (SDLs) and non-stylet-driven leads (NSDLs) for CSP is largely operator-dependent, lacking substantial comparative data.

Purpose of the Study:

• To compare the procedural characteristics and clinical outcomes of SDLs versus NSDLs in patients undergoing CSP.
• To analyze data from the National Cardiovascular Data Registry (NCDR) to evaluate lead performance in CSP.

Main Methods:

• Analysis of 11,412 CSP implantations recorded in the NCDR Electrophysiology Device Implant Registry between April 2021 and December 2023.
• Descriptive analysis of baseline and procedural factors, alongside in-hospital outcomes, comparing SDL and NSDL groups.
• Multivariable logistic regression was employed to assess in-hospital outcomes, controlling for patient and hospital-level variables.

Main Results:

• NSDLs were predominantly used (87.7%), but SDL usage increased over the study period.
• Patients receiving SDLs presented with more severe heart failure (61.6% vs. 48.6%) and lower LVEF (42.3% vs. 47.4%) compared to NSDL recipients.
• Implant success rates were slightly higher for SDLs (98.4% vs. 96.2%), with similar low overall complication rates (2.8% vs. 2.1%) and no significant differences in adverse events or mortality.

Conclusions:

• Both SDLs and NSDLs demonstrate high implant success rates and low complication profiles in a large national cohort undergoing CSP.
• The findings support the safety and efficacy of both lead types for CSP.
• Lead selection for CSP can be based on operator preference, given the comparable outcomes.