Initial Experience with Left Bundle Branch Area Pacing in a General Hospital

BACKGROUND This study evaluates the procedural success rates, operative learning curves, and post-procedural complications associated with the initial clinical adoption of left bundle branch area pacing (LBBAP) at a provincial cardiovascular tertiary-care center. METHODS This retrospective cohort study evaluated 56 consecutive patients with clinical indications for permanent pacemaker implantation who underwent left bundle branch area pacing (LBBAP) during the first year of institutional adoption (May 2024 to May 2025) at the tertiary cardiovascular center of Banphaeo General Hospital, Samut Sakhon, Thailand. Primary endpoints included procedural success rates, chronological trends in procedural duration evaluated across four consecutive quarters, and procedurerelated complications. RESULTS The cohort (median age 73.5 years; 55.4% female) presented with a high prevalence of non-communicable diseases (82.5%). Main indications were complete heart block (46.4%) and sick sinus syndrome (26.8%). Successful LBBAP capture—evidenced by a left ventricular activation time (LVAT) and a right bundle branch block morphology—was achieved in 85.7% of cases. Electrophysiological outcomes showed a significant reduction in mean QRS duration post-implantation (p < 0.001), with 89.5% of patients achieving a QRS duration < 130 ms. Chronological analysis revealed a clear operative learning curve; median procedural times steadily declined by 32.6%, from 95.0 minutes in Quarter 1 (n=14) to 65.0 minutes in Quarter 4 (n=14), alongside a narrowing of data variability. The overall complication rate was 1.8%, consisting of a single lead dislodgement 10 days postprocedure. CONCLUSION LBBAP demonstrates high procedural success and a favorable safety profile, with efficiency improving significantly through accumulated operator experience.