Adopting permanent His bundle pacing: learning curves and medium-term outcomes

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• His bundle pacing (HBP) is an alternative to traditional pacing methods.
• Understanding procedural characteristics and outcomes is crucial for adoption.
• Electrophysiologist learning curves impact HBP implementation.

Purpose of the Study:

• To determine procedural characteristics, acute success rates, and medium-term outcomes of His bundle pacing (HBP).
• To evaluate the learning curves of electrophysiologists adopting HBP.
• To identify factors influencing HBP success and potential complications.

Main Methods:

• Retrospective analysis of consecutive HBP patients from three hospitals.
• Extraction of clinical characteristics, procedural details, and medium-term outcomes from electronic medical records.
• Assessment of acute procedural success, pacing parameters, and follow-up complications.

Main Results:

• Acute procedural success rate was 81.1% in 233 patients (mean age 74.6 years).
• Broad QRS was associated with lower HBP success (OR 0.39, P=0.02).
• Procedural and fluoroscopic times decreased and plateaued after 30-40 cases per operator; 56.7% had persisting HBP capture.

Conclusions:

• Physicians should consider the learning curve and select non-dependent patients with normal QRS and LVEF to minimize lead revision risk.
• Rising HBP thresholds may increase battery drain and reoperation needs, impacting device selection for cardiac resynchronization therapy.