Comparison of Procedural Outcomes of Lumenless Fixed-Helix Versus Stylet-Driven Extendable-Helix Lead Systems in Left Bundle Branch Pacing: COMPARE LBBP

BACKGROUND: Left bundle branch pacing (LBBP) has emerged as a safe and effective alternative to right ventricular pacing. Traditionally, LBBP is performed with lumenless lead (LLL); however, the use of stylet-driven lead (SDL) is on rise. We aimed to assess acute success and procedural outcomes of SDL versus LLL for LBBP. METHODS: One hundred consecutive patients with bradyarrhythmia, indication of cardiac resynchronization therapy, or ablate and pace strategy were randomized in a 1:1 fashion to the SDL and LLL arms. Tendril STS lead with a CPS Locator 3D catheter and SelectSecure 3830 lead with a C315HIS catheter were used in the SDL and LLL arms, respectively. LBBP was confirmed by standard criteria with measurements done on Labsystem Pro. RESULTS: Patients in the LLL arm were significantly younger (71.9±11 versus 76.4±8.9 years; P =0.02); all other baseline characteristics were not significantly different. Acute success in LBBP was similar with SDL versus LLL (90% versus 92%; P =0.7). In patients with successful LBBP, screw attempts were not significantly different between the groups (2.3±1.7 in SDL versus 1.9±1.3 in LLL; P =0.2). Implant duration (11±9.6 versus 9.9±7.1 minutes; P =0.4), mean fluoroscopy dose (65.3±82.7 versus 53.5±50.5 mGy; P =0.5), and fluoroscopy time (7.8±4.8 versus 7.4±4 minutes; P =0.7) were also not different in the SDL versus the LLL arm, respectively. Incidence of lead failure ( P =0.6), microdislodgement ( P =1), and macrodislodgement ( P =0.6) were not significantly different. Pacing threshold was comparable at implant and on follow-up at 1, 3, and 6 months. CONCLUSIONS: LBBP was feasible with both lead systems with similar success rate and low capture threshold. No significant difference was observed in procedure duration or fluoroscopy use. No major complications were recorded with either lead. REGISTRATION: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12624000304538.