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

Background: Left bundle branch area pacing (LBBAP) requires implantation of the lead deep in the interventricular septum. We developed a novel implantation method, which does not require dedicated delivery catheters, but only a manually shaped three-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 two 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 y., 48.3% 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 min. vs 9.6 min.), 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), capture threshold (0.63 V vs 0.83 V), higher percentage of confirmed LBB captures, (98.3% vs. 77.4%) and a numerically higher occurrence of delayed perforations (2/115 vs. 0/115) in 3D styled group.

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