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Related Experiment Video

Updated: Jan 13, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing.

Ionuț Tudorancea1,2, Mihai Ștefan Cristian Haba1,2, Mircea Cristian Placinta1

  • 1Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.

Journal of Clinical Medicine
|January 10, 2026
PubMed
Summary

Left bundle branch area pacing (LBBAP) is a physiological alternative to conventional pacing. Cumulative sum (CUSUM) analysis objectively identifies operator proficiency in LBBAP, demonstrating a learning curve for new practitioners.

Keywords:
cardiac resynchronization therapyconduction system pacingcumulative sum (CUSUM) analysislearning curveleft bundle branch pacingoperator training

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Left bundle branch area pacing (LBBAP) offers a physiological alternative to traditional pacing methods.
  • The learning curve for operators new to LBBAP is not well-defined.
  • This study investigates the LBBAP learning curve using cumulative sum (CUSUM) analysis.

Purpose of the Study:

  • To characterize the learning curve for Left bundle branch area pacing (LBBAP) in a single-operator setting.
  • To assess the utility of cumulative sum (CUSUM) analysis in defining procedural proficiency.
  • To evaluate the impact of the learning phase on fluoroscopy time, electrical performance, and safety.

Main Methods:

  • Retrospective analysis of 108 consecutive LBBAP procedures by a novice operator.
  • Fluoroscopy time as the primary metric for procedural efficiency.
  • CUSUM plots used to identify the inflection point of proficiency acquisition based on predefined time targets.

Main Results:

  • Fluoroscopy time decreased significantly in non-CRT cases (n=95), with proficiency attained around 65 cases.
  • CRT implant cases (n=9) showed proficiency shortly after the non-CRT threshold.
  • Electrical parameters and safety outcomes remained consistent throughout the learning period.

Conclusions:

  • CUSUM analysis offers an objective, real-time measure of operator learning for LBBAP.
  • The CUSUM technique effectively identifies proficiency transitions in LBBAP procedures.
  • This method can aid in training, credentialing, and competency monitoring for LBBAP adoption.