Learning Curve for Left Bundle Branch Area Pacing Lead Implantation
Maci Clark1, Hannah Zerr1, Ben Ose1
1The University of Kansas School of Medicine, Kansas City, KS, USA.
Summary
New operators experienced a learning curve with left bundle branch area pacing (LBBAP), requiring more fluoroscopy and attempts. However, outcomes improved with experience, showing successful LBBAP implantation is achievable.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Left bundle branch area pacing (LBBAP) is an emerging technique for cardiac pacing.
- Understanding the learning curve for LBBAP implantation is crucial for widespread adoption and training.
Purpose of the Study:
- To analyze the learning curve associated with initial Left Bundle Branch Area Pacing (LBBAP) implantation.
- To compare procedural success and adverse events between operators with limited (<10) versus extensive (>10) LBBAP experience.
Main Methods:
- Retrospective analysis of 288 adult patients undergoing LBBAP from 2020-2023.
- Comparison of operators with ≤10 (LBBAPinexp) vs. >10 (LBBAPexp) implant attempts.
- Successful LBBAP defined as left ventricular activation time (LVAT) ≤80 ms.
Main Results:
- Less frequent successful LBBAP (LVAT ≤80 ms) in LBBAPinexp vs. LBBAPexp (56.9% vs. 72.4%, P=.04).
- Longer fluoroscopy times (12.6 vs. 8.2 min, P<.0001) and more attempts (2.0 vs. 2.9, P=.03) in LBBAPinexp.
- No significant difference in paced QRS duration, operator-identified success, or device-related adverse events.
Conclusions:
- Operators demonstrate a learning curve for LBBAP, with initial implants requiring more fluoroscopy and attempts.
- Achieving optimal LBBAP outcomes (LVAT ≤80 ms) improves with operator experience.
- Despite the learning curve, LBBAP can be safely adopted with comparable adverse event rates.
