Single operator experience, learning curve, outcomes, and insights gained with conduction system pacing

Background Conduction system pacing (CSP) is increasingly utilized to prevent and correct dyssynchrony. Barriers to CSP adoption include limited training, methodologic variability, laboratory slot allocation, and few data on learning curves. We report learning curves/clinical outcomes from a single...

Full description

Saved in:

Bibliographic Details
Published in:	Pacing and clinical electrophysiology Vol. 47; no. 2; pp. 211 - 221
Main Authors:	Marion, William, Schanz, John D., Patel, Sonali, Co, Michael Lawrenz, Pavri, Behzad B.
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-02-2024
Subjects:	Bundle of His Cardiac Conduction System Disease Cardiac Pacing, Artificial - methods Conduction conduction system pacing EKG Electrocardiography - methods Fluoroscopy His‐bundle pacing Humans Learning Learning Curve Learning curves left‐bundle area pacing physiologic pacing Retrospective Studies Transplants & implants Treatment Outcome conduction system pacing physiologic pacing left-bundle area pacing His-bundle pacing
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background Conduction system pacing (CSP) is increasingly utilized to prevent and correct dyssynchrony. Barriers to CSP adoption include limited training, methodologic variability, laboratory slot allocation, and few data on learning curves. We report learning curves/clinical outcomes from a single experienced electrophysiologist who was new to CSP, and share gained insights. Methods Retrospective analysis of all patients who underwent attempted CSP implantation (2016–2023). Patient characteristics, ECGs, echocardiograms, fluoroscopy/procedure times, lead data were recorded at implant and follow‐up. Results CSP leads were implanted successfully in 167/191(87.4%) patients with a follow‐up of 278 ± 378 days. His‐bundle pacing (HBP = 59) and left‐bundle‐area pacing (LBAP = 108) had similar procedure/fluoroscopy times, QRS duration decreases, and ejection fraction improvements (all p > NS). Eight HBP lead revisions were required for high capture thresholds LBAP demonstrated lower pacing thresholds, higher lead impedances, and greater R‐wave amplitudes at implant and follow‐up. After 25 HBP cases, implant pacing thresholds, fluoroscopy, procedural times did not decrease. After 25 LBAP cases, there were significant decreases in all these parameters (p < 0.05). A separate analysis in LBAP patients with recorded Purkinje signals showed no differences in paced ECG characteristics between patients with pre‐ QRS Purkinje signals versus patients with Purkinje signals post‐QRS onset. Conclusions Experienced implanters who are new to CSP can achieve steady‐state procedural/fluoroscopy times after a learning curve of 25 implants. LBAP showed lower capture thresholds and higher success rates. Adequate depth of lead deployment (as determined by published parameters) does not require Purkinje potential to be pre‐QRS. Operators new to CSP.can forego HBP and directly implement LBAP.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0147-8389 1540-8159
DOI:	10.1111/pace.14926