Comparative Analysis of Different Manufacturer Products for Left Bundle Branch Area Pacing: a Real-world Single Center Experience

Abstract

Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing alternative. However, limited data exist comparing different manufacturer systems for this technique. This prospective single-center study evaluated the real-world performance of four manufacturer systems during our learning phase with LBBAP. We included 214 consecutive patients who underwent LBBAP between July 2021 and March 2025 using Biotronik (n = 44), Abbott (n = 35), Boston Scientific (n = 46), and Medtronic (n = 88) systems. The overall success rate was 83.2%, with significant differences among manufacturers (Medtronic, 93.2%; Boston Scientific, 78.3%; Abbott, 77.1%; and Biotronik, 72.7%; p < 0.001). Success rates improved over time, from 0% in the initial cases to consistently above 80% from mid-2024 onward, demonstrating a clear learning curve. The Medtronic lumenless lead system showed superior performance despite its inability to perform continuous unipolar electrogram monitoring during lead advancement. Advanced age did not negatively impact success rates, with similar outcomes between patients aged < 70 years (81.5%) and ≥ 70 years (84.8%, p = 0.11). The overall complication rate was 6.5%, with septal perforation (3.3%) and lead dislodgement (2.3%) being the most common complications. Each manufacturer system presented distinct advantages and limitations: the Medtronic system offered higher success rates but more lead dislodgements (4.5%), whereas stylet-driven leads provided better electrogram monitoring but lower success rates. Our findings suggest that the Medtronic lumenless lead system is preferred for centers implementing LBBAP, particularly during the learning phase, while highlighting the importance of understanding the unique technical characteristics of each system.