The Zwolle Experience with Left Bundle Branch Area Pacing Using Stylet-driven Active Fixation Leads

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 18

PMID 35716195

Authors

F Daniels

A Adiyaman

K M Aarnink

F J Oosterwerff

J R A Verbakel

A Ghani

J J J Smit

M A Kanters

P P H M Delnoy

A Elvan

Affiliations

Soon will be listed here.

Abstract

Aims: Left bundle branch area pacing (LBBAP) is a novel physiological pacing modality and is regarded as a viable alternative to His bundle pacing. LBBAP has mostly been performed with the lumen-less permanent pacing lead (SelectSecure™ Model 3830, Medtronic, Inc.) with a fixed helix. The aim of this study was to compare the non-stylet driven lumen-less lead (LLL) (Medtronic 3830) with a standard stylet-driven active fixation lead (SDL) (Tendril™ STS Model 2088TC-38, Abbott Laboratories) in terms of lead parameters, procedural success and complication rates.

Methods: Patients receiving a LBBA pacemaker in the Isala Hospital, The Netherlands, were prospectively enrolled. The majority received a standard right ventricular (RV) lead as backup, the implanter chose between LLL and SDL for the LBBAP lead.

Results: The study included 94 patients with a mean follow-up of 30 weeks. 30/31 LLL procedures were successful, compared with 62/63 in the SDL group. Including the participants that lost LBBAP during follow-up resulted in success rates of 90.3% for LLL versus 96.8% for SDL, P = 0.199. Mean number of deployments was significantly lower in the SDL group compared with the LLL group (2 ± 2.3 versus 4 ± 3.4, P = 0.005), implantation and procedural times were comparable. Pacing thresholds were low and remained low in both groups (at last follow-up 0.8 ± 0.30 V for LLL versus 0.6 ± 0.20 V for SDL). Complication rates did not differ significantly between both groups, P = 0.805.

Conclusion: LBBAP using SDL is feasible and has comparable success rates with lower number of deployments of the active fixation screw.

Citing Articles

Stylet-driven leads compared with lumenless leads for left bundle branch area pacing: a systematic review and meta-analysis.

Chen X, Dong J BMC Cardiovasc Disord. 2024; 24(1):598.

PMID: 39462327 PMC: 11514867. DOI: 10.1186/s12872-024-04273-4.

Stylet-driven Leads or Lumenless Leads for Conduction System Pacing.

Cano O, De Pooter J, Zanon F Arrhythm Electrophysiol Rev. 2024; 13:e14.

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Alternative pacing strategies for optimal cardiac resynchronization therapy.

Hua J, Kong Q, Chen Q Front Cardiovasc Med. 2022; 9:923394.

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