Comparison of Procedure and Fluoroscopy Time Between Left Bundle Branch Area Pacing and Right Ventricular Pacing for Bradycardia: The Learning Curve for the Novel Pacing Strategy.

Zhao Wang,Xiaofei Li,Haojie Zhu,Zhimin Liu,Xiaohan Fan,Yan Yao

doi:10.3389/fcvm.2021.695531

Abstract

Background: Left bundle branch area pacing (LBBAP) is a novel physiological pacing approach.Objective: To assess learning curve for LBBAP and compare the procedure and fluoroscopy time between LBBAP and right ventricular pacing (RVP).Methods: Consecutive bradycardia patients who underwent LBBAP or RVP were prospectively recruited from June 2018 to June 2020. The procedure and fluoroscopy time for ventricular lead placement, pacing parameters, and periprocedural complications were recorded. Restricted cubic splines were used to fit learning curves for LBBAP.Results: Left bundle branch area pacing was successful in 376 of 406 (92.6%) patients while 313 patients received RVP. Learning curve for LBBAP illustrated initial (1–50 cases), improved (51–150 cases), and stable stages (151–406 cases) with gradually increased success rates (88.0 vs. 90.0 vs. 94.5%, P = 0.106), steeply decreased median procedure (26.5 vs. 14.0 vs. 9.0min, P < 0.001) and fluoroscopy time (16.0 vs. 6.0 vs. 4.0min, P < 0.001), and shortened stimulus to left ventricular activation time (Sti-LVAT; 78.7 vs. 78.1 vs. 71.2 ms, P < 0.001). LBBAP at the stable stage showed longer but close median procedure (9.0 vs. 6.9min, P < 0.001) and fluoroscopy time (4.0 vs. 2.8min, P < 0.001) compared with RVP.Conclusion: The procedure and fluoroscopy time of LBBAP could be reduced significantly with increasing procedure volume and close to that of RVP for an experienced operator.

Highlights

Traditional right ventricular pacing (RVP) has been extensively used in clinical practice for more than 50 years
Learning curve for Left bundle branch area pacing (LBBAP) illustrated initial (1–50 cases), improved (51–150 cases), and stable stages (151–406 cases) with gradually increased success rates (88.0 vs. 90.0 vs. 94.5%, P = 0.106), steeply decreased median procedure (26.5 vs. 14.0 vs. 9.0 min, P < 0.001) and fluoroscopy time (16.0 vs. 6.0 vs. 4.0 min, P < 0.001), and shortened stimulus to left ventricular activation time (Sti-LVAT; 78.7 vs. 78.1 vs. 71.2 ms, P < 0.001)
The middle- and long-term feasibility and safety of LBBAP have been demonstrated in patients with symptomatic bradycardia or advanced heart failure [8, 9]

Summary

Introduction

Traditional right ventricular pacing (RVP) has been extensively used in clinical practice for more than 50 years. Biventricular pacing can maintain interventricular electromechanical synchrony and has been proposed as an alternative to RVP in patients with heart failure and atrioventricular block (AVB) [4]. His bundle pacing (HBP) has been the most physiological pacing modality since 2000 [5]. Left bundle branch area pacing (LBBAP), first reported by Huang et al [7] has emerged as a promising physiological pacing modality with stable low threshold and other pacing parameters. Compared with RVAP or RVSP, LBBAP presents a significantly narrower pQRSd, similar pacing parameters, and significantly longer procedure and fluoroscopy time [8, 11, 12]. Left bundle branch area pacing (LBBAP) is a novel physiological pacing approach

Methods

Results

Discussion

Conclusion