B-po05-045 early experience with a novel fixed curve delivery system with stylet-driven leads for permanent left bundle branch pacing

Left bundle branch pacing (LBBP) has emerged as an alternative method for conduction system pacing. Data of the performance of different delivery systems for this technique are limited. To describe early experience with stylet-driven leads implanted via a new fixed curve delivery system, the Boston Scientific Site Selective Pacing Catheter (SSPC), for LBBP. Forty-six consecutive patients (mean age 73.2 ± 10.7 years; 25 (54% male)) undergoing attempted LBBP at a single institution were identified. Cases were grouped by sheath system manufacturer used: Boston Scientific SSPC (BSC, n = 18) or Medtronic C315HIS or C304-HIS (MDT, n = 28). Baseline characteristics were recorded, and procedural outcomes including successful LBBP, paced QRS duration, final pacing thresholds and R-wave amplitudes were examined and compared between the BSC and MDT cohorts. Successful LBBP was achieved in 80% of patient with similar success rates in the BSC and MDT cohorts (78% vs 82%, p = NS) (Table). Higher mean R-wave amplitudes were identified in the BSC cohort compared to the MDT cohort (13.4 ± 5.8 mV vs. 10.0 ± 3.9 mV; p=0.02). Similar paced QRS durations and pacing thresholds were seen. Compared to the MDT system, use of the BSC delivery system was associated with significantly shorter fluoroscopy times (9.8 ± 7.4 mins vs. 15.5 ± 8.1 mins; p = 0.02) and a trend towards reduced procedure times. The Boston Scientific SSPC system performs comparably well to the Medtronic C315HIS and C304-HIS for LBBP and may result in decreased fluoroscopy times. Long-term follow-up of lead performance following use of this delivery system is warranted.Tabled 1Characteristic - no. (%) unless notedBoston Scientific (n=18)Medtronic (n=28)p-valueSuccessful LBBP Achieved14 (77.8)23 (82.1)p = 0.721Presence of LB potential5 (27.8)10 (35.7)p = 0.749Paced QRS duration (ms - mean ± std. dev.)132 ± 22130 ± 20p = 0.782Pacing threshold (V - mean ± std. dev.)0.72 ± 0.260.72 ± 0.31p = 0.941R-wave amplitude (mV - mean ± std. dev.)13.4 ± 5.810.0 ± 3.9p = 0.022Pacing impedance (ohms - mean ± std. dev.)838 ± 252804 ± 209p = 0.622Fluoroscopy Time (minutes - mean ± std. dev.)9.8 ± 7.415.5 ± 8.1p = 0.021Procedure Time (minutes - mean ± std. dev.)95.6 ± 39.9125 ± 56.1p = 0.061 Open table in a new tab