Learning Curve and Initial Experience With Implementation of a His-Bundle Pacing Program in an Australian Setting.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• His-bundle pacing (HBP) offers an alternative to traditional right ventricular pacing, potentially reducing pacing-induced dyssynchrony.
• Limited data exist on HBP implementation and outcomes by less experienced operators and centers.

Purpose of the Study:

• To evaluate the implementation and outcomes of a His-bundle pacing program in an Australian setting.
• To assess the impact of operator experience on procedural success and efficiency.

Main Methods:

• Retrospective analysis of 140 consecutive His-bundle pacing procedures across three centers (March 2018 - September 2019).
• Cohort divided into early (1-47), middle (48-94), and late (95-140) procedure groups to assess learning curve effects.
• Analysis of procedural success rates, implant thresholds, QRS duration changes, and procedural times relative to operator experience.

Main Results:

• Overall procedural success rate was 87% with a median implant threshold of 0.8V@1 ms.
• Procedural success rates did not differ significantly across experience groups (early 83%, middle 89%, late 89%).
• Median procedural time significantly decreased with experience (early 98 mins, middle 83 mins, late 70 mins).
• Lower success rates were observed in patients with atrioventricular (AV) block (73%), prior device (69%), moderate-severe tricuspid regurgitation (69%), and those requiring right-sided access (25%).

Conclusions:

• His-bundle pacing is a feasible procedure with demonstrated improvements in procedural efficiency over time.
• Operator experience positively impacts procedural time but not necessarily overall success rates.
• Specific patient factors including AV block, previous cardiac devices, significant tricuspid regurgitation, and need for right-sided access may negatively influence procedural success.