Study limitations
The main study limitations were the small sample size and the lack of randomization in the assignment to one or other technique, which were conducted during different time periods. Experience was first acquired with HBP, which may have influenced the reduced fluoroscopy time observed with LBBAP. A further limitation was the wide variety in the clinical situations of the patients, reducing the statistical power for comparisons between subgroups. Some differences that were close to significant may have reached statistical significance with a larger sample size; nevertheless, it proved adequate to detect statistically significant between-group differences in some outcomes. One study strength is that all procedures were conducted by one surgeon, avoiding inter-operator variability. In general, the results obtained for paced QRS width, threshold, and sensed R-wave amplitude were comparable to those published in studies with larger sample sizes. Randomized studies are warranted to compare these techniques in larger samples of patients in different clinical situations.