Comparing Efficacy and Complications Between Stylet-Driven Leads and Lumenless Leads in Left Bundle Branch Area Pacing.

BACKGROUND

Left bundle branch area pacing (LBBAP) is an emerging technique in conduction system pacing (CSP) that may offer improved outcomes over traditional methods. Typically, lumenless leads are used; however, stylet-driven leads have recently been considered. This study conducts a systematic review and meta-analysis evaluating the efficacy and complications of stylet-driven leads versus lumenless leads.

METHOD: Databases including PubMed, Embase, and Scopus were searched from inception to June 2024 for relevant studies. We included published prospective or retrospective randomized controlled trials and cohort studies using stylet-driven leads or lumenless leads for LBBAP. Data were combined using a random-effects, generic inverse variance method of DerSimonian and Laird.

RESULTS

Sixty-eight studies involving 8996 patients from 2016 to 2023 were included. From eight head-to-head studies, the stylet-driven leads group had a comparable success rate (OR = 1.46, 95% CI: 0.89, 2.39) but showed shorter procedural time (weighted mean difference [WMD] = -16.82 min, 95% CI: -24.42, -9.21). Stylet-driven leads had a higher pacing threshold at implantation (WMD = 0.09 V, 95% CI: 0.00, 0.17) and lower lead impedance (WMD = -86.13 ohms, 95% CI: -129.46, -42.80). QRS duration and R wave amplitude were comparable initially, but at follow-up (1-12 months), stylet-driven leads had a lower R wave amplitude (WMD = -1.92 mV, 95% CI: -3.33, -0.51). Complication rates were higher with stylet-driven leads (OR = 1.80, 95% CI: 1.34, 2.41), particularly lead dislodgement (OR = 3.26, 95% CI: 1.75, 6.07) and helix damage (OR = 11.46, 95% CI: 3.58, 36.63).

CONCLUSION

In this meta-analysis of 8996 patients, stylet-driven leads for LBBAP showed a comparable success rate to lumenless leads but was associated with a higher complication risk.