Key result
Supervised beginner conduction system pacing matches expert clinical outcomes but prolongs procedure and fluoroscopy times.
Why the study?
Education in conduction system pacing is mandatory in modern EP programs, requiring acceptable implant success rates and adequate electrical parameters while ensuring patient safety during skill acquisition.
Does conduction system pacing implantation by a supervised beginner compared to a single expert operator affect clinical and technical outcomes?
Cohort (n=255)
Does conduction system pacing implantation by a supervised beginner compared to a single expert operator affect clinical and technical outcomes?
Conduction system pacing implantation by a supervised trainee yields equivalent clinical and technical outcomes to an expert operator, albeit with longer procedural and fluoroscopy times.
Supports supervised beginner training for conduction system pacing; leaves open efficiency and scalability questions.
Background The his bundle pacing (HBP) and Left bundle branch pacing (LBBp) techniques are quickly increasing in the cardiovascular interest being the most physiological mode of pacing. Education in these new conduction system pacing (CSP) is mandatory in the modern EP programs. Achieving acceptable implant success rate, together with electrical parameters adequacy is required. Objective The aim of the study was to compare clinical and technical outcomes in 2 groups of patients, those implanted by a single operator with large expertise in CSP and those implanted by two operators (one of them during his learning curve). Methods Data from 255 consecutive patients (mean age 78±9 years; 186 males) who underwent successful HBP or LBBp implants were collected and analyzed. The operators were classified as expert after performing more than 50 procedures. Baseline caracteristics were not significantly different between the two groups. Results After a mean follow-up of 20±10months, we found that there were no differences between patients implanted by 1 single expert operator and 2 operators (1 beginner during his learning cirve supervised by 1 expert operator) in terms of clinical end point (composite of death or heart failure hospitalizations) and technical end point (need for surgical revision of the implant for reason other than battery replacement). Fluoroscopy time (16±17 min vs 9.8±11 min; p 0.004) and procedural time (113±48 min vs 16±17 min; p 0.003) were significantly prolonged when the implant was performed by 2 operators. Conclusions Skill acquisition in physiological pacing (both HBP and LBBp) is a nowadays process which cannot put patient's safety at risk. Our experience shows that clinical and technical outcomes were equivalent when the implant was performed by an expert operator or a beginner operator supervised by 1 expert operator. Fluoroscopy time and duration of the procedure were significantly prolonged by the presence of a trainees. Kaplan Meyer curves Funding Acknowledgement Type of funding source: None
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Zanon et al. (2020) conducted a cohort in His bundle pacing (HBP) or Left bundle branch pacing (LBBp) (n=255). Implantation by two operators (one beginner supervised by an expert) vs. Implantation by a single expert operator was evaluated on Composite of death or heart failure hospitalizations, and need for surgical revision of the implant. Conduction system pacing by a supervised beginner yielded equivalent clinical outcomes to an expert, but prolonged fluoroscopy (16 vs 9.8 min; P=0.004) and procedural times (113 vs 16 min; P=0.003).
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