Few Sequoia updates ago (15.2 or 15.3.0) I have found that sometimes I need to press keyboard shortcut twice to make it working.
I'm using BTT 5.168
do you have any other keyboard related apps running?
Keyboard Maestro for example. But set of apps was not changed for longer time and they have no problems with working. Keyboard shortcuts were not changed too. So I think that there can be problem with BTT keyboard sensing mechanism.
Unfortunately I have never experienced this, but I have had a few (very few, which makes it hard to track) similar reports since Sequoia. All of them had in common that some other apps like keyboard maestro or karabiner were running.
I will try to track if disabling Keyboard Maestro solves the problem.
how often does this happen for you?
It is hard to find frequency. But I'm noticing it quite frequently.
Maybe the problem is other. I have just checked and found that in fact one of keyboard shortcuts (fn V) works but one of step doesn't work. This step is Paste Items (screenshot attached)
ah this is probably an issue related to the latest alpha in combination with a trigger that was configured > 1 year ago. I'll have a look!
For now, delete the paste items action and add it again, that should fix it.
deleting/adding action done the work
I really like BTT, but it's dynamic development without backward compatibility can cause problems...
I will observe problem with need to repeat shortcut trigger.
Just an alpha bug, in general BTT is backward compatible down to the first version released in 2009 
(which makes some things quite challenging)
Oh, no! Old bug just comes back. deleting/adding paste action effects that when using shortcut, BTT changes active app instead of pasting text in active one.
With the configuration in your screenshot? Is it maybe related to the apple script?