Introduction
Right ventricular pacing (RVP) has been the standard approach to obtain ventricular pacing for many decades, but is associated with an increased risk for pacing-induced cardiomyopathy and mortality.1, 2 Both His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) aim to directly capture the His Purkinje system and are therefore deemed to be more physiologic pacing alternatives.3-6 LBBAP captures the His Purkinje system more distally compared to HBP and requires the lead to be screwed transseptally towards the left side of the interventricular septum. Compared to HBP, LBBAP is associated with lower pacing thresholds and better sensing values, overcoming two important limitations of HBP.6-9 Most experience with LBBAP has been performed using a lumen-less pacing lead (LLL) with fixed helix design (SelectSecure 3830 pacing lead, Medtronic Inc, Minnaepolis, MN, USA), delivered through a preshaped sheath dedicated for HBP (C315His, Medtronic).4, 6, 7, 10-13 This implant technique yields high succes rates, both in patients with bradycardia and heart failure indications. Although data on HBP with standard stylet-driven leads (SDL) delivered through preshaped sheaths have been published14, experience with LBBAP using SDL with extendable helix design is limited to two recent case reports.15 This study aims to compare implant success and short-term pacing characteristics of LBBAP using either LLL or SDL.