CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing

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.