Adoption of left bundle branch area pacing using stylet-driven lead in a tertiary academic training center: Learning curve and acute procedural outcomes

Abstract

Background

Left bundle branch area pacing (LBBAP) has recently emerged as a strategy for conduction system pacing.

Objective

The purpose of this study was to evaluate the initial learning experience and acute procedural success in adopting this procedure in an academic training center.

Methods

A retrospective review of LBBAP procedures using the Biotronik Solia stylet-driven lead from June 2022 to December 2023 was performed. Procedural and fluoroscopy times with electrocardiographic and pacing parameters were evaluated to determine safety and acute procedural outcomes.

Results

A total of 69 patients (mean age 75 ± 12 years; 60.9% male) underwent LBBAP implantation over 18 months for standard pacing indications by 10 implanters (including 7 fellows-in-training) without previous experience in LBBAP technique. Mean total procedural time was 74.1 ± 23.5 minutes, and mean fluoroscopy time for LBBAP lead insertion was 9.3 ± 5.4 minutes. Mean paced QRS duration was 115.2 ± 15.5 ms, and mean left ventricular activation time was 79.4 ± 14.5 ms. An rsRʹ pattern was achieved in 76.8%. LBBAP was successful in 78.3% (overall 43.5% single deployment; median 2 [interquartile range 1–3]) with excellent LBBAP lead parameters: threshold 0.8 ± 0.4 V at 0.4 ms; sensing 9.4 ± 4.2 mV; impedance 627 ± 131 Ω. Acute procedural complications included damaged lead helix requiring a second lead (4.3%), pneumothorax (2.9%), and acute LBBAP lead dislodgment (1.4%). Septal perforation occurred in 10.1% of cases with no acute sequelae. When analyzed in tertiles, the number of lead deployment attempts was significantly reduced with no changes to procedural success rates with increasing experience.

Conclusion

Adoption of LBBAP with stylet-driven lead in an academic training center is feasible and safe, with satisfactory success rates and no overly steep learning curve.