Left bundle branch area pacing with stylet-driven pacing leads: implantation technique

BackgroundTraditional right ventricular apical pacing can cause electrical–mechanical dyssynchrony. Therefore, physiological conduction system pacing was considered and became the reason for developing His bundle pacing (HBP). Recently, left bundle branch area pacing (LBBAP) has been implemented, which overcomes the shortcomings of HBP. Most initial large LBBAP studies reported that LBBAP was achieved through a lumenless pacing lead (LLL) with a fixed helix design; however, it is unavailable in Korea. LBBAP delivery sheaths using a conventional standard stylet-driven pacing lead (SDL) with an extendable helix design are currently available in Korea. In this review, we describe the methods and procedural skills required to perform the LBBAP using conventional SDL.Main bodyLBBAP has emerged as a new physiological CSP modality and has shown a stable and lower capture threshold and achieved a similarly paced QRS duration compared to HBP. It has also demonstrated stable early outcomes for feasibility and safety with a high success rate. Furthermore, the application of LBBAP has recently been extended to a resynchronization strategy. The LBBAP with SDL requires different handling and lead preparation owing to differences in lead and helix designs. Reported procedure-related acute complications of LBBAP include septal perforation during the procedure, pneumothorax, pocket infection, pocket hematoma, and lead dislodgements occurring during follow-up.ConclusionLBBAP with conventional SDL has similar implant success rates, procedural safety, and pacing characteristics as LBBAP with LLL. However, LBBAP with SDL requires different handling and lead preparation from that of LLL owing to the differences in the lead and helix designs.