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.