Learning curve and initial experience for left bundle branch area pacing
with standard stylet-driven pacing leads: comparison with conventional
right ventricular pacing
Abstract
Introduction: His bundle pacing (HBP) was developed as a
physiological conduction system pacing to complement the problem of
conventional right ventricular pacing (RVP) related to dyssynchrony.
Recently, left bundle branch area pacing (LBBAP), which overcomes the
shortcomings of HBP, has been implemented. Most researches on initial
experiences with LBBAP have reported that it was achieved through a
lumen-less pacing lead (LLL) with a fixed helix design; however, there
are situations in which LLL cannot be used. The purpose of present
research is to evaluate the initial experience and learning curve of
LBBAP using a standard stylet-driven lead with an extendable helix
design. Methods: 265 patients who underwent LBBAP or
conventional RVP performed by operators without previous LBBAP
experience at Yonsei University Severance Hospital in Korea between
December 2020 and October 2021 were enrolled. LBBAP was performed using
a stylet‐driven pacing lead with an extendable helix. The learning curve
was evaluated by analyzing fluoroscopy and procedure times.
Results: LBBAP was successful in 65 of 69 (94.2%) patients
during the observation period. In 65 patients who underwent LBBAP, mean
fluoroscopy and procedural times were 17.1 ± 17.2 minutes and 64.2 ±
33.5 minutes, respectively. The learning curve for achieving LBBAP
plateaued after the 24th case, with a gradually shortened in procedure
time. Conclusion: During the initial experience with LBBAP,
fluoroscopy and procedural times improved with increasing operator
experience. For operators who were experienced in cardiac pacemaker
implantation, the steepest part of the learning curve was over the first
20-25 cases.