Stylet-driven leads versus lumenless pacing leads in patients with left bundle branch area pacing: A systematic review and meta-analysis

Abstract

Background

Despite advancements in lead designs for optimum left bundle branch area pacing (LBBAP), limited data exist on the performance of stylet-driven leads (SDLs).

Objective

This meta-analysis sought to compare the performance and safety of SDLs in comparison with lumenless leads (LLLs) following LBBAP.

Methods

Systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that compared the outcomes of SDLs during LBBAP compared with LLLs. Study outcomes included periprocedural parameters, pacing metrics, and complications.

Results

A total of 6 studies involving 3991 participants were included. LBBAP procedural success was comparable between SDLs and LLLs (90.2% and 90.5%, respectively). Compared with LLLs, SDLs appeared to result in shortened procedural (–11.50 minutes) and fluoroscopy (–2.56 minutes) times, along with increased capture threshold and reduced lead impedance at implantation. However, paced QRS, R-wave amplitude, capture threshold, and lead impedance remained comparable between both groups during follow-up. The number of lead-implantation attempts was similar between SDLs and LLLs (2.6 ± 1.0 vs 2.2 ± 0.6). Lead dislodgement and lead-related complications (except septal perforation) occurred mostly in the SDL group. No statistical differences were found in life-threatening complications.

Conclusion

SDLs demonstrated comparable effectiveness in achieving LBBAP, exhibiting similar success rates, mean attempts for lead placement, and pacing parameters, although they were associated with a higher overall incidence of lead-related complications. The reduced overall procedural and fluoroscopy time may be attributed to the ability of SDLs’ different delivery sheath selections in identifying the optimal anatomical site, rather than being lead specific.