Both stylet-driven and non-stylet-driven leads for conduction system pacing (CSP) exhibited high implant success and low complication rates, highlighting the safety and effectiveness of both lead types, according to a recent study published in Heart Rhythm.

Including 11,412 CSP lead implants from the ACC's EP Device Implant Registry, Aashish Katapadi, MD, et al., compared in-hospital outcomes of procedures conducted with either stylet-driven or non-stylet-driven leads. Of the total number of procedures analyzed between April 2021 and December 2023, 10,005 were with non-stylet-driven leads and 1,407 were with stylet-driven leads, although stylet-driven lead use did increase significantly over the course of the study period. Patients who received stylet-driven leads were found to have higher rates of heart failure and lower LVEF.

In the stylet-driven lead group, rates of implant success were slightly higher than the non-stylet-driven lead group (98.4% vs. 96.2%; p<0.001) and complication rates between the two study groups were similar (2.8% vs. 2.1%; p=0.089).

When looking at specific complications, the authors noted no difference in rates of perforation, lead dislodgement or mortality between the two groups. There was also no association between lead type and likelihood of complications or prolonged hospitalization.

"These findings support the procedural safety of both platforms and suggest that lead selection may be guided by operator preference, patient characteristics and institutional practice patterns," write the authors. "Further randomized studies are warranted to clarify long-term outcomes and guide evidence-based lead selection."