Procedural Outcomes and Conduction System Capture Pattern Maintenance With the Tendril STS™ 2088TC Lead and CPS Locator™ 3D Delivery System: A Comparative Analysis With Lumenless Lead System.

Abstract

Introduction: Left bundle branch area pacing (LBBAP) is typically performed using the lumenless (LLL) Medtronic SelectSecure^TM Model 3830 pacing lead. Stylet-driven leads (SDL) for LBBAP were recently introduced.

Objective: To compare the Abbott Tendril STS^TM 2088TC SDL and CPS Locator^TM 3D delivery system to the Medtronic LLL and delivery system acutely and chronically.

Methods: Fifty consecutive patients who received SDL using the CPS Locator^TM 3D delivery system for standard pacing indications were included in this study. A comparison was made with 229 LLL patients from a retrospective database, evaluating baseline characteristics, procedural outcomes, lead and system performance, and follow-up data.

Results: LBBAP was successful in 84% of SDL and 79% of LLL patients (p = 0.55), with no significant differences in procedural characteristics or complications. Minor pacing differences were noted. CPS Locator^TM 3D performed similarly to C315His® delivery system with a trend for less lead placement attempts. Conduction system capture (CSC) pattern at implant did not differ between both groups. CSC maintenance was similar between SDL and LLL. However, follow-up QRS duration was significantly longer in SDL group (154 ms vs. 129 ms, p = 0.004), suggesting a possibility of CSC loss in some patients.

Conclusion: SDL is a viable alternative to LLL, demonstrating comparable acute and midterm pacing parameters. CPS Locator^TM 3D delivery system showed comparable performance and an excellent safety profile. Acute CSC with SDL and LLL is similar, but its long-term maintenance will require further study.