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Assessing the Learning Curve in Conduction System Pacing Implantation.

Amato Santoro1, Claudia Baiocchi1, Maurizio Collantoni2

  • 1Division of Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Viale Bracci 11, 53100 Siena, Italy.

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|December 30, 2025
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Summary
This summary is machine-generated.

Conduction system pacing (CSP) implantation time stabilizes after about 45 cases per operator. Procedural complexity in CSP depends on patient factors like left ventricular end-diastolic diameter and operator experience, not lead type.

Keywords:
conduction system pacinghis bundle pacingleft bundle branch pacing area

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Conduction system pacing (CSP) is an alternative to biventricular pacing (BiVp).
  • Early CSP utilized His bundle pacing (HBP) with lumenless leads (LLL).
  • Left bundle branch area pacing (LBBAP) and standardization have simplified CSP techniques.

Purpose of the Study:

  • To evaluate the learning curve for conduction system pacing (CSP) implantation.
  • To analyze the impact of experience on procedural times and complexity.
  • To identify predictors of procedural duration in CSP.

Main Methods:

  • Retrospective analysis of the first 55 CSP procedures per operator (n=110).
  • Assessment of implantation and fluoroscopy times in blocks of five cases.
  • Univariate and multivariable linear regression to determine predictors of procedural complexity.

Main Results:

  • Implantation time plateaued after approximately 45 cases per operator.
  • Fluoroscopy time stabilized earlier with no significant inter-operator differences.
  • Left ventricular end-diastolic diameter (LVEDD) and implant number were independent predictors of procedure duration.

Conclusions:

  • CSP implantation demonstrates a clear learning curve, with procedural duration stabilizing around 45 cases.
  • Patient factors (LVEDD) and operator experience are key determinants of CSP complexity.
  • Differences in lead types (LLL vs. standard leads) reflect historical trends rather than inherent technical limitations.