Practical and systematic approach using the steerable catheter and stylet-driven lead to deliver safe and effective left bundle branch area pacing

Introduction: Current delivery tools were not designed for left bundle branch area pacing (LBBAP). Challenges using these tools include lack of reach into the right ventricle and poor support for the lead to penetrate the interventricular septum. Concerns using stylet-driven leads (SDL) for LBBAP have been previously highlighted. Knowledge and the technical know-how of using SDL for LBBAP need to be evaluated in a fair and consistent manner. A stepwise approach is devised for use of Agilis HisPro (TM) steerable catheter with Tendril STS Model 2088TC lead for LBBAP and evaluated for safety and reproducibility. Methods: Consecutive patients undergoing LBBAP using the stepwise approach with Agilis HisPro (TM) steerable catheter were analyzed. The safety, efficacy and reproducibility of the technique were evaluated. The lead parameters were analyzed in the immediate (1 day) and short-term period (3-6 months) post implantation. Results: LBBAP was attempted in 41 patients using the stepwise approach of which 37 (90.7%) were successful. The lead parameters were stable in the immediate and short-term post implantation in all our patients. There was no significant difference between the group of patients with multiple repositioning of the lead compared to those successful at the 1st attempt. There were no acute or short-term lead and procedural complications. Conclusion: A stepwise and systematic approach using the Agilis HisPro (TM) steerable catheter and proper handling of the Tendril STS Model 2088TC stylet-driven lead is an important part of the armamentarium to deliver LBBAP in a practical, effective and reproducible manner.