Comparison of stylet-driven and lumenless leads for left lundle branch area pacing in heart failure patients: impact on acute and follow-up capture
U Dietrich, A Traub, S Reincke, S Hatahet, J P Wenzel, C Eitel, J Nikorowitsch, R R TilzAbstract
Background
Left bundle branch area pacing (LBBAP) is an increasingly used physiological pacing approach. Various lead designs exist, including lumenless and stylet-driven systems, but comparative data regarding procedural performance and mid-term outcomes remain limited.
Purpose
To compare procedural characteristics, implantation success, and electrical performance at implantation and during standardized follow-up among three pacing leads used for LBBAP: one lumenless lead and two stylet-driven leads.
Methods
Patients undergoing LBBAP implantation were retrospectively analysed and grouped by lead type. Baseline characteristics, procedural data, and follow-up results were recorded. Implantation success was defined as stable lead placement with LBBA capture confirmed by ECG criteria. Two different stylet-driven leads were used. Lead body diameter and tip electrode length were 4.1F and 1.8mm for the lumenless lead, 5.6F and 1.8mm for the stylet-driven lead-A (SDL-A); 5.8F and 2.0mm for stylet-driven lead-B (SDL-B). Pairwise statistical comparisons were conducted with a Wilcoxon test.
Results
Eighty-four (n = 84) patients (mean age was 75.8 ± 10.5 years; mean BMI 27.5 ± 5.2 kg/m²; 72.5 % male (p >0,05)) were included (n = 46 lumenless leads, n = 38 stylet-driven leads with n = 13 SDL-A and n = 25 SDL-B). Mean LVEF was 36.5 ± 9.4 %. Device indications were bradycardia in 42 patients and resynchronization in 68 patients with multiple indications possible. Baseline QRS duration was 155.1 ± 23.4 ms (p >0,05). Overall implantation success was 87.0 %. The stylet-driven leads demonstrated shorter procedure times (82.6 ± 24.3 min vs. 93.8 ± 28.0 min) and lower radiation exposure (235.6 ± 130.3 cGy*cm² vs 489.2 ± 614.2 cGy*cm²) compared with the lumenless leads (p <0.05). Mean QRS narrowing after implantation was 29.7 ± 10.5 ms (p >0,05). A standardized follow-up was performed after 3 months (mean 80.7 days) with an overall LBBAP capture rate of 70.2 %. All leads showed stable capture thresholds and sensing amplitudes. A comparison of LBBAP capture loss across all leads did not reveal differences between lead types (p >0.05). No major complications occurred, with only one lead revision in the lumenless lead group.
Conclusion
Stylet-driven and non–stylet-driven leads demonstrated similarly safe and effective outcomes in LBBAP, with comparable acute and follow-up success, stable electrical parameters and without major complications. Stylet-driven leads enabled shorter procedures and lower radiation exposure. Results are limited by the single-centre, retrospective design, sample size, and potential influence of operator experience on procedural duration and success. All lead types demonstrated excellent mid-term reliability, supporting flexible lead selection according to operator experience, anatomy, and lead design.