Kamsani Suraya Hani, Fitzgerald John L, Thiyagarajah Anand, Evans Shaun, Jayakumar Mohanaraj, Ariyaratnam Jonathan P, Malik Varun, O'Shea Catherine, Pitman Bradley M, Wong Christopher X, Emami Mehrdad, Young Glenn D, Lau Dennis H
Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia.
Heart Rhythm O2. 2024 Dec 27;6(3):253-258. doi: 10.1016/j.hroo.2024.12.009. eCollection 2025 Mar.
Left bundle branch area pacing (LBBAP) has recently emerged as a strategy for conduction system pacing.
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.
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.
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.
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.
左束支区域起搏（LBBAP）最近已成为一种传导系统起搏策略。
本研究的目的是评估在学术培训中心采用该手术的初始学习经验和急性手术成功率。
对2022年6月至2023年12月使用百多力Solia鞘管驱动导线进行的LBBAP手术进行回顾性分析。评估手术和透视时间以及心电图和起搏参数，以确定安全性和急性手术结果。
在18个月内，10名植入者（包括7名培训学员）对69例患者（平均年龄75±12岁；60.9%为男性）进行了LBBAP植入，这些植入者此前均无LBBAP技术经验，植入用于标准起搏适应症。平均总手术时间为74.1±23.5分钟，LBBAP导线插入的平均透视时间为9.3±5.4分钟。平均起搏QRS时限为115.2±15.5毫秒，平均左心室激动时间为79.4±14.5毫秒。76.8%的患者实现了rsR'图形。LBBAP成功率为78.3%（总体43.5%单次植入；中位数2[四分位间距1 - 3]），LBBAP导线参数优异：阈值在0.4毫秒时为0.8±0.4伏；感知为9.4±4.2毫伏；阻抗为627±131欧姆。急性手术并发症包括导线螺旋受损需要更换第二根导线（4.3%）、气胸（2.9%）和急性LBBAP导线脱位（1.4%）。10.1%的病例发生了间隔穿孔，无急性后遗症。按三分位数分析时，随着经验增加，导线植入尝试次数显著减少，手术成功率无变化。
在学术培训中心采用鞘管驱动导线进行LBBAP是可行且安全的，成功率令人满意，且学习曲线不过于陡峭。
