Stylet-driven vs non-stylet-driven leads for conduction system pacing: Insights from the NCDR Electrophysiology Device Implant Registry.

BACKGROUND

Conduction system pacing (CSP), including His bundle pacing and left bundle branch area pacing, is a growing alternative to traditional right ventricular or biventricular pacing. The choice between stylet-driven leads (SDLs) and non-stylet-driven leads (NSDLs) remains operator-dependent, with limited comparative data.

OBJECTIVE

The purpose of this study was to compare characteristics and outcomes of SDLs and NSDLs for CSP using data from the National Cardiovascular Data Registry.

METHODS

We analyzed 11,412 CSP lead implants from April 2021 to December 2023 in the National Cardiovascular Data Registry Electrophysiology Device Implant Registry. A descriptive analysis of baseline and procedural characteristics, as well as crude in-hospital outcomes, was performed between the study groups. In addition, in-hospital outcomes were assessed using multivariable logistic regression, accounting for the patient- and hospital-level covariates.

RESULTS

NSDLs (87.7%, n = 10,005) were the predominant lead type, though SDL (12.3%, n = 1407) use increased significantly over time. Compared with NSDL recipients, patients receiving SDLs had higher rates of heart failure (61.6% vs 48.6%; P < .001) and lower left ventricular ejection fraction (42.3% vs 47.4%; P < .001). Implant success was slightly higher with SDLs (98.4% vs 96.2%; P < .001). Overall complication rates were low and similar (2.8% vs 2.1%; P = .089), with no statistical differences in perforation, lead dislodgment, or mortality. Lead type was not associated with increased odds of complications or prolonged hospitalization.

CONCLUSION

In this large national cohort, both SDLs and NSDLs achieved high implant success with low complication rates. These findings support the safety and effectiveness of either lead type and suggest selection may be guided by operator preference.