# Riding the Highs and Lows of the Conduction System Pacing Wave—Our Experience

## TL;DR

This paper shares the experience of using two types of leads for left bundle branch pacing, comparing their effectiveness and safety in patients needing pacemakers.

## Contribution

The study provides a comparative analysis of lumenless and stylet-driven leads for LBBP with a focus on procedural and follow-up outcomes.

## Key findings

- No significant difference in procedural time or paced QRS duration between lumenless and stylet-driven leads.
- Fluoroscopy time was significantly longer for stylet-driven leads.
- Lumenless leads showed higher and more stable impedance values during follow-up.

## Abstract

Conduction system pacing started with His bundle pacing (HBP) and then rapidly switched gears into left bundle branch pacing (LBBP). We describe our center’s experience with LBBP using either lumenless leads (LLLs) or stylet-driven leads (SDLs). Patients who were admitted to two tertiary centers between 1 April 2021 and 30 June 2024 and met the guidelines for pacing were recruited and prospectively followed up. A total of 124 patients underwent permanent pacemaker (PPM) implantation using the LBBP technique with a mean follow-up of 19.7 ± 13.3 months. In total, 90 patients were implanted with LLLs and 34 with SDLs. There was no significant difference in the procedural time and final paced QRS duration, but fluoroscopy time was significantly longer in the SDLs (26.2 ± 17.7 min vs. 17.5 ± 13.0 min, respectively, p = 0.026). The on-table impedance values were also significantly higher in the LLLs, and this persisted throughout the follow-up. There were no differences in the rates of complications. The success of conduction system pacing implantation with SDLs and LLLs is comparable with reasonable safety and reliable outcomes. Good pre-implant patient selection will contribute to improved outcomes.