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

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 rsR' 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.