Stylet-driven leads vs. lumenless leads as modality for left bundle branch area pacing: A systematic literature review and meta-analysis

Abstract Left bundle branch area pacing (LBBAP) offers cardiac synchrony benefits over conventional ventricular pacing. Although many procedures and studies on LBBAP have used lumenless pacing lead (LLL), stylet-driven pacing lead (SDL) can also be used. This study compared LLLs and SDLs in LBBAP through a systematic review and meta-analysis of the literature. The PubMed, Embase, and Cochrane Library databases were searched for full-text articles on LBBAP from their respective inception dates to 9 April 2024. The studies comparing LLLs and SDLs were extracted, and electrophysiological characteristics and procedural outcomes were analysed. Of 2201 articles on LBBAP, 7 met the inclusion criteria of comparing LLLs and SDLs as implanted pacing leads. The overall pooled analysis showed non-inferiority in implant success rates for SDLs compared with LLLs for LBBAP (89% vs. 94%, odds ratio: 0.80, 95% confidence interval: 0.37–1.72, P = 0.566). The paced QRS duration of LBBAP using SDL was not significantly different from that using LLLs (standardised mean difference: −0.19 ms, 95% confidence interval: −0.50 to 0.12, P = 0.239). There was no difference in stimulus to left ventricular activation time and paced QRS duration between the two groups. Follow-up pacing parameters were stable in both groups.