Procedural Outcomes and Conduction System Capture Pattern Maintenance With the Tendril STS™ 2088TC Lead and CPS Locator™ 3D Delivery System: A Comparative Analysis With Lumenless Lead System.

Introduction: Left bundle branch area pacing (LBBAP) is typically performed using the lumenless (LLL) Medtronic SelectSecure Model 3830 pacing lead. Stylet-driven leads (SDL) for LBBAP were recently introduced.

Objective: To compare the Abbott Tendril STS 2088TC SDL and CPS Locator 3D delivery system to the Medtronic LLL and delivery system acutely and chronically.

Methods: Fifty consecutive patients who received SDL using the CPS Locator 3D delivery system for standard pacing indications were included in this study. A comparison was made with 229 LLL patients from a retrospective database, evaluating baseline characteristics, procedural outcomes, lead and system performance, and follow-up data.

Results: LBBAP was successful in 84% of SDL and 79% of LLL patients (p = 0.55), with no significant differences in procedural characteristics or complications. Minor pacing differences were noted. CPS Locator 3D performed similarly to C315His® delivery system with a trend for less lead placement attempts. Conduction system capture (CSC) pattern at implant did not differ between both groups. CSC maintenance was similar between SDL and LLL. However, follow-up QRS duration was significantly longer in SDL group (154 ms vs. 129 ms, p = 0.004), suggesting a possibility of CSC loss in some patients.

Conclusion: SDL is a viable alternative to LLL, demonstrating comparable acute and midterm pacing parameters. CPS Locator 3D delivery system showed comparable performance and an excellent safety profile. Acute CSC with SDL and LLL is similar, but its long-term maintenance will require further study.