Learning Curve for Left Bundle Branch Area Pacing Lead Implantation.

Q3 Medicine
Journal of Innovations in Cardiac Rhythm Management Pub Date : 2025-05-15 eCollection Date: 2025-05-01 DOI:10.19102/icrm.2025.16055
Maci Clark, Hannah Zerr, Ben Ose, David Fritz, Caroline Trupp, Amulya Gupta, Ahmed Shahab, Amit Noheria, Seth H Sheldon
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引用次数: 0

Abstract

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 (LBBAPinexp) versus >10 (LBBAPexp) 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 LBBAPinexp group versus 220 (76%) patients in the LBBAPexp 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 LBBAPinexp compared to LBBAPexp (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 LBBAPinexp (12.6 ± 10.1 vs. 8.2 ± 8.0 min; P < .0001). The average number of attempts at LBBAP was lower with LBBAPinexp versus LBBAPexp (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.

左束支起搏导联植入的学习曲线。
左束支区起搏(LBBAP)在经验丰富的中心显示出良好的效果;然而,对于最初采用LBBAP植入的学习曲线知之甚少。我们对某学术医疗中心LBBAP的学习曲线进行了回顾性分析(2020-2023年)。我们比较了7位具有5年LBBAP植入经验的新操作者在LBBAP植入史≤10 (LBBAPinexp)和> (LBBAPexp) LBBAP植入史的操作者在LBBAP植入史上的手术成功率和器械相关不良事件。LBBAP成功定义为左心室激活时间(LVAT)≤80 ms。7名手术人员植入LBBAP装置288例(年龄73±11岁;其中,基线特征相似的LBBAPinexp组68例(24%),LBBAPexp组220例(76%)。每位手术者植入物的中位数为22(范围8-83)。植入后LVAT≤80 ms在LBBAPinexp组的发生率低于LBBAPinexp组(56.9% vs 72.4%;P = .04)。节律性QRS持续时间≤130 ms无显著差异(75.9% vs. 76.1%;P = 1.0)或操作者自我识别的成功率(85% vs 91%;P = .2)。使用新的单腔/双腔器械种植体,种植时间无差异(103.4±31.8 vs 101.6±38.5 min);P = .3),但使用LBBAPinexp的透视时间较长(12.6±10.1 vs 8.2±8.0 min;P < 0.0001)。LBBAPinexp对LBBAPexp的平均尝试次数较低(2.0±1.5比2.9±2.9;P = .03)。两组患者器械相关不良事件发生率无差异(P = .3)。操作者较少使用透视检查,对LBBAP进行更多尝试,并且在前10次植入后更频繁地达到LVAT≤80 ms。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Innovations in Cardiac Rhythm Management
Journal of Innovations in Cardiac Rhythm Management Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.50
自引率
0.00%
发文量
70
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