Comparison of Clinical Outcomes Between Left Bundle Branch Area Pacing With a Stylet‐Driven Lead and Conventional Right Ventricular Pacing

Left bundle branch area pacing (LBBAP) has been shown to reduce the risk of pacing-facilitated heart failure (HF) compared to right ventricular pacing (RVP), but limited data exists comparing LBBAP with stylet-driven leads (SDL) and conventional RVP. The study aims to compare clinical outcomes between LBBAP using SDL and conventional RVP. From December 2018 to December 2023, patients who underwent pacemaker implantation at two tertiary hospitals were enrolled. Exclusions included those requiring cardiac resynchronization therapy and patients with ventricular pacing burden ≤ 10%. LBBAP was performed using SDL (Solia S60, Biotronik) with a fixed curve delivery sheath. Composite outcome I consisted of HF admission, pacing-induced cardiomyopathy (defined as an LVEF decline of ≥ 10% or below 50%), and upgrade to biventricular pacing. Composite outcome II included all-cause death in addition to the components of composite outcome I. A total of 738 patients (mean age 72.1 years; 52% of men; 243 LBBAP vs. 495 RVP) were included. Atrioventricular block was more common pacing indication in LBBAP group than RVP group (88.1% vs. 69.3%, p < 0.001). Compared to RVP group, ventricular pacing burden was higher in the LBBAP group (96% vs. 86%, p < 0.001). LBBAP was associated with a lower risk of composite outcome I and II compared to RVP (adjusted HR 0.27 [95% confidence interval 0.11-0.68], p = 0.006 for composite outcome I, aHR 0.41 [0.20-0.84], p = 0.015 for composite outcome II), mainly driven by a lower risk of pacing-induced cardiomyopathy by 70%. There were no significant differences in procedure-related complications. LBBAP with SDL was associated with a lower risk of adverse clinical outcomes compared to conventional RVP in patients requiring substantial ventricular pacing.