Relationship between site procedural volumes and outcomes of left bundle branch area pacing using stylet-driven leads from the INSIGHT-LBBA Registry

Abstract

Background Left bundle branch (LBB) area pacing (LBBAP) is increasingly used for patients with a ventricular pacing indication. Multi-center studies analyzing predominantly lumenless leads have suggested a learning curve for LBBAP; however, analogous data on stylet-driven leads (SDLs) are lacking. Objective To assess the relationship between site volume and procedural outcomes and complications using the INGEVITY+ SDL for LBBAP. Methods A secondary analysis of the INSIGHT-LBBA multi-site registry was performed, with retrospective data collected across 8 United States sites performing LBBAP with INGEVITY+ SDLs between 2020 and 2023. Outcomes included LBBAP and LBB capture success rates, pacing parameters, fluoroscopy time, number of leads used, and lead-related complications. Outcomes were assessed using a generalized estimated equation based on consecutive implants. A sensitivity analysis was performed restricted to only single- and dual-chamber LBBAP implants. Results A total of 1374 patients were enrolled in the primary INSIGHT-LBBA registry. Overall LBBAP success and LBB capture success rates were 94.5% and 78.1%, respectively. LBBAP success rate improved with experience (odds ratio, 1.09; 95% confidence interval, 1.03–1.14, per every 10 successive LBBAP implants; P = .001), with similar results in the sensitivity analysis. Fluoroscopy times and complication rates remained low (10.0 ± 9.2 minutes and 2.7%, respectively). Conclusion In this secondary analysis of INSIGHT-LBBA using INGEVITY+ SDLs, LBBAP and LBB capture success rates were high and improved with consecutive implants, indicative of a learning curve for implantation. Fluoroscopy times and complication rates remained low without significant change during consecutive implants. These data add to the growing literature supporting safe and effective use of SDLs for LBBAP.