Assessing the Learning Curve in Conduction System Pacing Implantation

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.