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

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-02-01 DOI:10.1016/j.hroo.2024.11.006

Giky Karwiky MD , William Kamarullah MD , Raymond Pranata MD , Mohammad Iqbal MD, PhD , Chaerul Achmad MD, PhD , Januar Wibawa Martha MD, PhD , Iwan Setiawan MD, PhD

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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.

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左束支区起搏患者的风格驱动导联与无腔起搏导联：系统回顾和荟萃分析

尽管在最佳左束分支区域起搏（LBBAP）导联设计方面取得了进展，但关于风格驱动型导联（sdl）性能的数据有限。目的：本荟萃分析旨在比较LBBAP后SDLs与无腔导联（LLLs）的性能和安全性。方法使用PubMed、Europe PMC和ScienceDirect进行系统的文献检索，比较LBBAP期间SDLs与LLLs的结果。研究结果包括围手术期参数、起搏指标和并发症。结果共纳入6项研究，受试者3991人。LBBAP手术成功率在SDLs和LLLs之间具有可比性（分别为90.2%和90.5%）。与LLLs相比，SDLs似乎缩短了手术时间（-11.50分钟）和透视时间（-2.56分钟），同时增加了捕获阈值，降低了植入时的导联阻抗。然而，在随访期间，两组间的节律性QRS、r波振幅、捕获阈值和导联阻抗保持可比性。SDLs和LLLs的铅植入次数相似（2.6±1.0 vs 2.2±0.6）。铅脱位和铅相关并发症（间隔穿孔除外）主要发生在SDL组。在危及生命的并发症方面没有统计学差异。结论：sdl在实现LBBAP方面表现出相当的有效性，表现出相似的成功率、导联放置的平均尝试次数和起搏参数，尽管它们与较高的导联相关并发症的总体发生率相关。总体手术和透视时间的减少可能归因于sdl不同的递送鞘选择识别最佳解剖部位的能力，而不是铅特异性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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