Learning Curve Analyses for Left Bundle Branch Area Pacing with Conventional Stylet-Driven Pacing Leads.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Physiological conduction system pacing is gaining traction to address right ventricular pacing (RVP) induced dyssynchrony.
• Left bundle branch area pacing (LBBAP) offers an alternative to His bundle pacing (HBP), demonstrating efficacy and safety.
• Stylet-driven leads (SDL) have proven feasible for LBBAP, complementing lumen-less leads.

Purpose of the Study:

• To evaluate the learning curve associated with performing Left bundle branch area pacing (LBBAP) utilizing a stylet-driven pacing lead (SDL).

Main Methods:

• A cohort of 265 patients undergoing LBBAP or RVP by inexperienced operators was analyzed.
• Left bundle branch area pacing was performed using SDL with an extendable helix.
• Learning curve assessment involved analyzing fluoroscopy and procedure times, comparing LBBAP duration to RVP duration pre- and post-learning curve.

Main Results:

• Left bundle branch area pacing (LBBAP) achieved a 100% success rate (50/50 patients), with 98.0% success for left bundle branch pacing (49/50).
• Mean fluoroscopy and procedure times for LBBAP were 15.1 ± 13.5 minutes and 59.9 ± 24.8 minutes, respectively.
• Fluoroscopy and procedure time plateaus were reached around the 25th and 24th cases, respectively.

Conclusions:

• Operator experience significantly improves fluoroscopy and procedural times during initial Left bundle branch area pacing (LBBAP) with stylet-driven leads (SDL).
• The learning curve for LBBAP using SDL is approximately 24-25 cases for experienced pacemaker implanters.
• This learning curve is notably shorter than those previously reported for His bundle pacing (HBP).