Efficacy and safety of left bundle branch area pacing performed with stylet-driven leads

Left bundle branch area pacing (LBBAP) has emerged as a physiological pacing strategy. LBBAP has been predominantly performed using the lumen-less lead.

This study aims to explore the efficacy and safety of LBBAP performed with stylet-driven leads (SDL) via site-selective pacing catheter (SSPC) sheaths.

We evaluated consecutive 79 patients undergoing LBBAP using standard stylet-driven active leads via SSPC sheaths. Pacing parameters (threshold, R-wave amplitude, impedance), QRS morphology and duration, left ventricular activation time in lead V5 and complication rates were analyzed. Postoperative measurements of lead parameters and complications were recorded at 1, 3, 6, and 12 months.

LBBAP was successfully achieved in 69 of the 79 patients (87.3%), with 7742 leads via SSPC sheaths, with 52 patients (65.8%) showing visible left bundle branch potentials. Mean paced QRS duration and left ventricular activation time in lead V5 were 111.1 ± 27.2 ms and 69.0 ± 11.7 ms. Intraoperative electrode parameters for SDL-LBBAP, including pacing threshold (0.8 ± 0.2 V at 0.4 ms), impedance (792.5 ± 140.7 ohms), and sensing amplitude (14.0 ± 5.9 mV), remained stable during the 12 month follow up. Intraoperative ventricular septal perforation occurred in six patients (7.6%), with no subsequent persistent ventricular septal defects. Procedural time and fluoroscopy exposure time were lower in the latter 39 patients, declining markedly as operator experience accumulated.

The application of SDL in LBBAP is safe and feasible, with excellent success rates and stable long term electrical performance.