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.