Long-Term Effects of Left Bundle Branch Pacing Using Stylet-Driven Lead on Left Ventricular Systolic Function: A Literature Review

Abstract

Background: Left bundle branch pacing (LBBP) has emerged as a physiological pacing strategy designed to preserve native ventricular activation and reduce the adverse effects of conventional right ventricular pacing. The introduction of stylet-driven leads for conduction system pacing has expanded accessibility, particularly in regions where lumenless systems are not readily available. Aim: To evaluate and summarize current evidence on the long-term effects of LBBP using stylet-driven leads on left ventricular systolic function, with emphasis on echocardiographic parameters such as mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (S’). Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases to identify studies published between 2018 and 2025. Relevant original research articles, systematic reviews, and consensus statements addressing LBBP, stylet-driven lead implantation, and echocardiographic outcomes were included. Results: Recent evidence demonstrates that left bundle branch pacing (LBBP) preserves or improves left ventricular systolic function compared with conventional right ventricular pacing. Improvements in MAPSE and S’ suggest better ventricular synchrony and contractile efficiency. From a safety perspective, the MELOS-RELOADED Registry reported similar procedure-related complication rates between left bundle branch area pacing (LBBAP) and right ventricular pacing (RVP), with stable capture thresholds and sensing parameters during follow-up. These findings support the safety of LBBAP when performed by experienced operators. Conclusion: LBBP using stylet-driven leads is a feasible and effective physiological pacing modality that maintains left ventricular systolic function and broadens access to conduction system pacing. Long-term multicenter studies are needed to establish its durability, optimize device performance, and evaluate impacts on clinical outcomes such as heart failure progression and mortality.

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