Abstract 4138640: Learning Curve for Left Bundle Branch Area Pacing Lead Implantation

Background: Left bundle branch area pacing (LBBAP) has shown promising outcomes at experienced centers, but less is known about the learning curve with new adoption of LBBAP. We conducted a retrospective analysis (2020-2023) of the learning curve for LBBAP at our center. Methods: Procedural success and complications in adult patients undergoing LBBAP by operators with >5-years’ experience in device implantation were compared between operators’ experience ≤10th (LBBAP inexp ) vs. >10th (LBBAP exp ) LBBAP implant. Successful LBBAP was defined as left ventricular activation time (LVAT) ≤80 ms. Results: Seven operators implanted LBBAP in 288 patients (age 73±11 years, 38% women): 68 (24%) in LBBAP inexp vs. 220 (76%) patients in LBBAP exp groups with similar baseline characteristics (all p >0.05). The median number of implants per operator was 22 (range 8-83). Table 1 shows the procedural characteristics and ECG results. Post-implant LVAT ≤80 ms was less frequent in LBBAP inexp compared to LBBAP exp (56.9% vs 72.4%, p=0.04, Figure 1 ). There were no differences in paced QRS duration ≤130 ms (75.9% vs. 76.1 %, p=1.0) or operator self-identified success (85% vs. 91%, p=0.2). With new single-/dual-chamber device implants, there was no difference in implant duration (103.4±31.8 vs. 101.6±38.5 minutes, p=0.3) but there was longer fluoroscopy in LBBAP inexp (12.6±10.1 vs. 8.2±8.0 minutes, p<0.0001, Figure 1 ). The average number of attempts at LBBAP was lower in LBBAP inexp vs. LBBAP exp (2.0 ± 1.5 vs. 2.9 ± 2.9, p=0.03). There was no difference in complications between the 2 groups ( Table 2 ). Conclusion: Operators use less fluoroscopy, make more attempts at LBBAP and more frequently achieve LVAT ≤80 ms after their first 10 implants.