Learning Curve for Left Bundle Branch Area Pacing Lead Implantation

Left bundle branch area pacing (LBBAP) has shown promising outcomes at experienced centers; however, less is known about the learning curve with initial adoption of LBBAP implantation. We conducted a retrospective analysis (2020-2023) of the learning curve for LBBAP at an academic medical center. Procedural success and device-related adverse events in adult patients undergoing LBBAP by seven new operators with >5 years' experience in device implantation were compared between operators with a history of ≤10 (LBBAP_inexp) versus >10 (LBBAP_exp) LBBAP implant attempts. Successful LBBAP was defined as a left ventricular activation time (LVAT) of ≤80 ms. Seven operators implanted LBBAP devices in 288 patients (age, 73 ± 11 years; 38% women), including 68 (24%) in the LBBAP_inexp group versus 220 (76%) patients in the LBBAP_exp group with similar baseline characteristics. The median number of implants per operator was 22 (range, 8-83). Post-implant LVAT ≤ 80 ms was less frequent in LBBAP_inexp compared to LBBAP_exp (56.9% vs 72.4%; P = .04). There were no significant differences in paced QRS duration ≤ 130 ms (75.9% vs. 76.1%; P = 1.0) or operator self-identified success (85% vs. 91%; P = .2). With new single-/dual-chamber device implants, there was no difference in implant duration (103.4 ± 31.8 vs. 101.6 ± 38.5 min; P = .3), but there was longer fluoroscopy with LBBAP_inexp (12.6 ± 10.1 vs. 8.2 ± 8.0 min; P < .0001). The average number of attempts at LBBAP was lower with LBBAP_inexp versus LBBAP_exp (2.0 ± 1.5 vs. 2.9 ± 2.9; P = .03). There was no difference in device-related adverse events between the two groups (P = .3). Operators use less fluoroscopy, make more attempts at LBBAP, and more frequently achieve LVAT ≤ 80 ms after their first 10 implants.