A Guide to Left Bundle Branch Area Pacing Using Stylet-Driven Pacing Leads

Abstract

Left bundle branch area pacing (LBBAP) has emerged as a novel pacing modality which aims to capture the left bundle branch area and avoids the detrimental effects of right ventricular pacing. Current approaches for LBBAP have been developed using lumen-less pacing leads (LLL). Expanding the tools and leads for LBBAP might contribute to a wider adoption of this technique. Standard stylet-driven pacing leads (SDL) differ from current LLL as they are characterized by a wider lead body diameter, are stylet-supported and often have a non-isodiametric extendable helix design. Although LBBAP can be performed safely with SDL, the implant technique of LBBAP differs compared to LLL. In the current overview we describe in detail how different types of SDL can be used to target a deep septal position and provide a practical guide on how to achieve LBBAP using SDL.

Success rates, challenges and troubleshooting of left bundle branch area pacing as a cardiac resynchronization therapy for treating patients with heart failure

“…For the past few years, stylet-driven pacing leads (SDL) has been reported to be safe and feasible during the procedure of LBBaP ( 50 ). However, the clinical data and experience about SDL are limited, and even less in the challenging patient such as heart failure.…”

Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives

“…CSP, in particular LBBAP, is currently performed using leads not designed and conceived initially with this scope (De Pooter et al, 2022); therefore, refinements in tools and technicalities of the procedure are necessary to improve the overall success rate and long-term safety profile.…”

Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy

“…The process of sheath delivery and lead positioning with SDL is similar to LLL, yet there are still some differences. For example, the lead body of the SDL is wider than that of the LLL due to the presence of an inner lumen, and the SDL is stiffer with the stylet inserted in this lumen (19). Growing evidence supports that LBBP using SDL can achieve a success rate, pacing parameters, and procedural safety comparable to those of LLL (19).…”

“…For example, the lead body of the SDL is wider than that of the LLL due to the presence of an inner lumen, and the SDL is stiffer with the stylet inserted in this lumen (19). Growing evidence supports that LBBP using SDL can achieve a success rate, pacing parameters, and procedural safety comparable to those of LLL (19). However, studies reporting the use of SDL remain limited, and an increasing number of large studies are required to confirm its feasibility.…”