Learning curve for left bundle branch area pacing with standard stylet-driven pacing leads

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: His bundle pacing (HBP) was developed as a physiological conduction system pacing to complement the problem of conventional right ventricular pacing (RVP) related to dyssynchrony. Recently, left bundle branch area pacing (LBBAP), which overcomes the shortcomings of HBP, has been implemented. Most studies on initial experiences with LBBAP have reported that it was achieved through a lumen-less pacing lead (LLL) with a fixed helix design; however, there are situations in which LLL cannot be used. This study aimed to evaluate the initial experience and learning curve of LBBAP using a standard stylet-driven lead with an extendable helix design. METHODS: The study included 265 patients who underwent LBBAP or conventional RVP performed by operators without previous LBBAP experience at our hospital in Korea between December 2020 and October 2021. LBBAP was performed using a stylet-driven pacing lead with an extendable helix. The learning curve was evaluated by analyzing fluoroscopy and procedure times. RESULTS: LBBAP was successful in 65 of 69 (94.2%) patients during the observation period. In 65 patients who underwent LBBAP, mean fluoroscopy and procedural times were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively. The learning curve for achieving LBBAP plateaued after the 24th case, with a gradually shortening procedure time. CONCLUSION: During the initial experience with LBBAP, fluoroscopy and procedural times improved with increasing operator experience. For operators who were experienced in cardiac pacemaker implantation, the steepest part of the learning curve was over the first 20-25 cases. It is shorter than the previously reported learning curves of HBP. [Figure: see text] [Figure: see text]