Safety and Efficacy of Stylet-Driven Leads for Left Bundle Branch Area Pacing in Octogenarians.

Background: Left bundle branch area pacing (LBBAP) is emerging as a physiological alternative to conventional pacing, particularly in elderly patients. Stylet-driven leads (SDL) offer unique procedural advantages, but data on their safety and efficacy in octogenarians remain sparse.

Objective: This study evaluates the feasibility, safety, and outcomes of SDL for LBBAP in octogenarians.

Methods: A retrospective, single-center study included 117 octogenarian patients (≥80 years) and 308 younger patients (<80 years) who underwent LBBAP with SDL between May 2022 and December 2023. Baseline characteristics, procedural success, and follow-up outcomes were analyzed. Complication rates and pacing parameters were assessed over 12 months.

Results: Procedural success was high in both groups (93.2% in octogenarians vs. 96.1% in younger patients). Octogenarians had slightly longer fluoroscopy times (13.2 ± 1.4 vs. 11.8 ± 1.6 min, p = 0.031) and higher pacing thresholds at implantation (1.03 ± 0.56 V vs. 0.82 ± 0.42 V, p = 0.001). At 12 months, event-free survival was 91.4% in octogenarians and 94.8% in younger patients (p = 0.288). The overall complication rate was low (5.1% vs. 3.6%, p = 0.957), and no significant differences in pacing parameters were observed between groups. Improvements in left ventricular ejection fraction (LVEF) and QRS duration were consistent across both cohorts.

Conclusion: SDLs are safe and effective for LBBAP in octogenarians, providing high procedural success and significant clinical improvements. These findings highlight the potential of SDL as a viable option for elderly patients requiring physiological pacing, addressing the unique challenges posed by advanced age.