Novel approach to left bundle branch area pacing lead implantation using a 3-dimensional stylet

Abstract

Background: Left bundle branch area pacing (LBBAP) requires implantation of the lead deep in the interventricular septum. We developed a novel implantation method that does not require dedicated delivery catheters but only a manually shaped 3-dimensional (3D) stiff stylet.

Objective: The aim of the study was to characterize procedural outcomes of this technique when used as a routine approach for LBBAP.

Methods: A case-control study compared procedural outcomes of consecutive patients who underwent pacemaker implantation at 2 centers: one using only the 3D stylet-based LBBAP technique and the other using the conventional catheter-based LBBAP lead implantation.

Results: A total of 400 patients (age, 75.3 ± 9.8 years; 48.5% female) were analyzed and 230 were matched and included in a 1:1 ratio in each arm of the implantation techniques. No differences were observed in the success rate (95.0% vs 94.8%), fluoroscopy time (9.9 minutes vs 9.6 minutes), paced QRS duration (151 ms vs 148 ms), and sensitivity values (8.2 mV vs 8.5 mV) between the 3D stylet-based and catheter-based techniques, respectively. Small differences were observed in V₆ R-wave peak time (73.2 ms vs 76.5 ms) and capture threshold (0.63 V vs 0.83 V), with a higher percentage of confirmed left bundle branch captures (98.3% vs 77.4%) and a numerically higher occurrence of delayed perforations (2/115 vs 0/115) in the 3D stylet group.

Conclusion: LBBAP lead implantation with the use of a manually shaped stiff 3D stylet is feasible and results in comparable outcomes to those achieved with leads implanted by dedicated preshaped delivery catheters.

Keywords: Conduction system pacing; Delivery catheter; Implantation technique; Lead stylet; Left bundle branch area pacing.