Stylet-driven Leads Compared with Lumenless Leads for Left Bundle Branch Area Pacing: a Systematic Review and Meta-analysis

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2024 Oct 27

PMID 39462327

Authors

Xuezhi Chen

Jianzeng Dong

Affiliations

Soon will be listed here.

Abstract

Objective: Left bundle branch area pacing (LBBAP) is a novel physiological pacing method for treating left ventricular dyssynchrony. LBBAP is often delivered using lumenless leads (LLL). However, recent studies have also reported the use of style-driven leads (SDL). This study is the first systematic review comparing the outcomes of LBBAP with SDL vs. LLL.

Methods: The review and meta-analysis included all available comparative studies published on Embase, PubMed, Web of Science, CENTRAL, and Scopus up to 6th March 2024.

Results: Eight observational studies were included in the review. Meta-analysis showed that success rates of LBBAP performed with LLL and SDL were comparable (OR: 1.72 95% CI: 0.94, 3.17 I = 38%). Duration of implantation and total procedural duration were significantly lower in LBBAP performed with SDL. The pacing threshold was significantly higher, while pacing impedance was significantly lower in the SDL compared to the LLL group. Pacing QRS interval, R-wave amplitude, and stimulus to peak left ventricular activation time were similar in the two groups. Intra-operative and post-operative dislodgement were significantly higher in the SDL group, but no difference was noted in intra-operative perforation and pneumothorax risk.

Conclusion: Limited evidence from observational studies with inherent selection bias shows that success rates for LBBAP may not differ between SDL and LLL. While implantation of SDL may be significantly faster, it carries a higher risk of lead dislodgement. Both SDL and LLL are associated with comparable pacing characteristics except for reduced pacing impedance with SDL.

References

Jastrzebski M, Kielbasa G, Cano O, Curila K, Heckman L, De Pooter J . Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J. 2022; 43(40):4161-4173. PMC: 9584750. DOI: 10.1093/eurheartj/ehac445. View

Richardson T, Himes A, Marshall M, Crossley G . Rationale for and use of the lumenless 3830 pacing lead. J Cardiovasc Electrophysiol. 2023; 34(3):769-774. DOI: 10.1111/jce.15828. View

De Pooter J, Ozpak E, Calle S, Peytchev P, Heggermont W, Marchandise S . Initial experience of left bundle branch area pacing using stylet-driven pacing leads: A multicenter study. J Cardiovasc Electrophysiol. 2022; 33(7):1540-1549. DOI: 10.1111/jce.15558. View

Cano O, Navarrete-Navarro J, Zalavadia D, Jover P, Osca J, Bahadur R . Acute performance of stylet driven leads for left bundle branch area pacing: A comparison with lumenless leads. Heart Rhythm O2. 2024; 4(12):765-776. PMC: 10774671. DOI: 10.1016/j.hroo.2023.11.014. View

Daniels F, Adiyaman A, Aarnink K, Oosterwerff F, Verbakel J, Ghani A . The Zwolle experience with left bundle branch area pacing using stylet-driven active fixation leads. Clin Res Cardiol. 2022; 112(12):1738-1747. PMC: 9206214. DOI: 10.1007/s00392-022-02048-5. View

Khurshid S, Epstein A, Verdino R, Lin D, Goldberg L, Marchlinski F . Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014; 11(9):1619-25. DOI: 10.1016/j.hrthm.2014.05.040. View

Miyajima K, Urushida T, Tomida Y, Tamura T, Masuda S, Okazaki A . Comparison of the left ventricular dyssynchrony between stylet-driven and lumen-less lead technique in left bundle branch area pacing using myocardial perfusion scintigraphy. Quant Imaging Med Surg. 2023; 13(10):6840-6853. PMC: 10585528. DOI: 10.21037/qims-23-357. View

Zanon F, Baracca E, Aggio S, Pastore G, Boaretto G, Cardano P . A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement. J Cardiovasc Electrophysiol. 2006; 17(1):29-33. DOI: 10.1111/j.1540-8167.2005.00285.x. View

Orlov M, Casavant D, Koulouridis I, Maslov M, Erez A, Hicks A . Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system. Heart Rhythm. 2019; 16(12):1825-1831. DOI: 10.1016/j.hrthm.2019.08.017. View

10.

Braunstein E, Kagan R, Olshan D, Gabriels J, Thomas G, Ip J . Initial experience with stylet-driven versus lumenless lead delivery systems for left bundle branch area pacing. J Cardiovasc Electrophysiol. 2022; 34(3):710-717. DOI: 10.1111/jce.15789. View

11.

Sun Y, Yao X, Zhou X, Jiang C, Zhang J, Sheng X . Preliminary experience of permanent left bundle branch area pacing using stylet-directed pacing lead without delivery sheath. Pacing Clin Electrophysiol. 2022; 45(8):993-1003. DOI: 10.1111/pace.14504. View

12.

Vijayaraman P, Bordachar P, Ellenbogen K . The Continued Search for Physiological Pacing: Where Are We Now?. J Am Coll Cardiol. 2017; 69(25):3099-3114. DOI: 10.1016/j.jacc.2017.05.005. View

13.

Le Polain De Waroux J, Wielandts J, Gillis K, Hilfiker G, Sorgente A, Capulzini L . Repositioning and extraction of stylet-driven pacing leads with extendable helix used for left bundle branch area pacing. J Cardiovasc Electrophysiol. 2021; 32(5):1464-1466. DOI: 10.1111/jce.15030. View

14.

Tops L, Schalij M, Holman E, van Erven L, van der Wall E, Bax J . Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol. 2006; 48(8):1642-8. DOI: 10.1016/j.jacc.2006.05.072. View

15.

Burri H, Jastrzebski M, Cano O, Curila K, De Pooter J, Huang W . EHRA clinical consensus statement on conduction system pacing implantation: executive summary. Endorsed by the Asia-Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS) and Latin-American Heart Rhythm Society (LAHRS). Europace. 2023; 25(4):1237-1248. PMC: 10105857. DOI: 10.1093/europace/euad044. View

16.

Deshmukh P, Casavant D, Romanyshyn M, Anderson K . Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000; 101(8):869-77. DOI: 10.1161/01.cir.101.8.869. View

17.

De Pooter J, Wauters A, Van Heuverswyn F, Le Polain De Waroux J . A Guide to Left Bundle Branch Area Pacing Using Stylet-Driven Pacing Leads. Front Cardiovasc Med. 2022; 9:844152. PMC: 8899462. DOI: 10.3389/fcvm.2022.844152. View

18.

Michowitz Y, Kronborg M, Glikson M, Nielsen J . The '10 commandments' for the 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021; 42(42):4295. DOI: 10.1093/eurheartj/ehab699. View

19.

Sritharan A, Kozhuharov N, Masson N, Bakelants E, Valiton V, Burri H . Procedural outcome and follow-up of stylet-driven leads compared with lumenless leads for left bundle branch area pacing. Europace. 2023; 25(10). PMC: 10563653. DOI: 10.1093/europace/euad295. View

20.

Su L, Wang S, Wu S, Xu L, Huang Z, Chen X . Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study. Circ Arrhythm Electrophysiol. 2021; 14(2):e009261. DOI: 10.1161/CIRCEP.120.009261. View