PO-621-06 SHORTER LEARNING CURVE OF LEFT BUNDLE PACING COMPARED TO HIS BUNDLE PACING

Abstract

Conduction system pacing (CSP) with His bundle pacing (HBP) or left bundle branch pacing (LBP) is an elegant method to provide single ventricular lead cardiac resynchronisation. The implant procedure utilises specialised sheaths and techniques to achieve the desired electrical resynchronisation. Inevitably there is a learning curve in mastering the nuances of sheath manipulation and electrogram/QRS interpretation during the implant. We present the learning curve associated with establishing a conduction system pacing program with both HBP and LBP. The first 30 cases of HBP and the first 30 cases of LBP included in this study. At our institution HBP was commenced in 2017 and LBP implantation in 2021. All CSP implanters are experienced Electrophysiologists who regularly implant complex devices. All implants included in both cohorts were performed using the Medtronic 3830 lead and either the C315 or C304 sheath. Patient characteristics were similar in both HBP and LBP groups including male sex (73% vs 57%, p=0.16), LV ejection fraction (46% vs 54%, p=0.08) or pre-procedural QRS duration (119ms vs 128ms, p=0.32). The mean procedural duration was shorter for LBP than for HBP (87 vs 107mins, p=0.04) and the drop in procedural duration was more marked in LBP, after the first 10 cases, and remained low at 70mins for the subsequent 20 cases (Figure 1). Fluoroscopic screening time was significantly shorter for LBP compared to HBP (8min 21sec vs 15min 46sec, p<0.01), with both CSP modalities there was a reduction in screening time with increased experience (Figure 2). R-waves were higher with LBP (12.8 vs 3.2mV, p<0.01) and pacing thresholds were lower with LBP (0.7 @0.5ms vs 1.4 @1.0ms, p<0.01). The CSP learning curve, evidenced by procedural duration, was shorter for LBP than for HBP. The LBP learning curve appears to plateaux after the first 10 cases after which the procedural duration is consistent and short at 70mins. The HBP learning curve is longer with continued improvement over the first 30 cases. Electrical parameters and fluoroscopy time were also more favourable for LBP than for HBP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)