Use of a Stylet Driven Lead With a Flexible Neck for Left Bundle Branch Area Pacing: A Single Center Experience.

Abstract

Background: The majority of data on left bundle branch area pacing (LBBAP) are on a lumenless lead. Data on the safety and effectiveness of stylet driven leads are comparatively lacking.

Methods: We retrospectively analyzed 265 patients who underwent attempted LBBAP with an 7842 (Boston Scientific, Marlborough, MA) lead in the Duke University Health System between 1/1/2020 and 9/1/2023. Outcomes of interest included post-operative 7842 helix extension (≥2 helix rotations beyond the lead tip), complications, and lead parameters. A nested analysis of single and dual chamber LBBAP attempts was performed to compare outcomes among similar patients who underwent attempted LBBAP with the lumenless 3830 (Medtronic, Mineappolis, MN) lead.

Results: LBBAP success with 7842 was 89.8%. Characteristics were similar among patients with (n = 238) and without (n = 27) successful implants. Helix extension was evaluable for 222 of 238 successful 7842 implants. Of evaluable leads, helix extension was complete for 174 leads (78%), and partial for 48 (21.6%). A trend towards lower dislodgement rates was observed in patients with full versus partial extension (2.9% vs. 8.3%, p = 0.0895) and the rate of full helix extension increased over time (64.1% over 24 months vs. 81.4% over 21 months, p = 0.0162). The success rate of 3830 LBBAP implants (n = 140) was 92.8% (p = 0.069 vs. 7842). At implant, R waves were similar for 7842 and 3830 leads but were greater for 7842 during follow-up (14.4 + /-0.77 vs. 11.3 + /-0.68, p = 0.004). Pacing impedances were higher with 7842 compared with 3830 at baseline (838 + /-10.44 ohms vs. 772 + /-14.58 ohms, p < 0.001) and during follow-up (652 + /-11.0 ohms vs. 513 + /-9.18 ohms, p < 0.001); similarly, 7842 pacing thresholds (@ 0.4 ms) were slightly higher at baseline (0.85 V + /-0.03 vs. 0.68 V + /-0.03, p < 0.001) and 6 months (0.95 V + /-0.03 vs. 0.80 V + /-0.03, p < 0.001) compared with those for the lumenless 3830.

Conclusion: LBBAP implant success rates, complications, and pacing parameters using the 7842 lead are stable over time, and appeared overall similar to the 3830 lead. Incomplete 7842 helix extension is a modifiable risk factor for lead dislodgement.