Fluoroscopy time decreased with proficiency achieved after approximately 65 cases in left bundle branch area pacing, indicating successful learning curve progression.
Does CUSUM analysis accurately identify the learning curve and proficiency transition point for a novice operator performing Left Bundle Branch Area Pacing?
CUSUM analysis demonstrates that a novice operator achieves procedural proficiency in LBBAP after approximately 65 cases, providing an objective tool for competency monitoring.
Absolute Event Rate: 0% vs 0%
Background/Objectives: Left bundle branch area pacing (LBBAP) has rapidly emerged as a physiological alternative to conventional pacing. However, the learning curve for new operators remains poorly characterized. We aimed to describe the learning curve of LBBAP using cumulative sum (CUSUM) analysis in a single-center, single-operator setting. Methods: We conducted a retrospective analysis of 108 consecutive LBBAP attempts performed by a first-time operator with no prior conduction system pacing experience. Fluoroscopy time was selected as the primary performance metric. A predefined procedural target (≤6 min for non-CRT and ≤9 min for CRT implants) was used to classify each case as a success or failure. CUSUM plots were generated to identify the inflection point marking proficiency acquisition. Results: In non-CRT cases (n = 95), fluoroscopy time progressively decreased, and the CUSUM curve showed a distinct inflection after approximately 65 cases, indicating the attainment of procedural proficiency. In CRT implants (n = 9), acceptable fluoroscopy exposure was achieved soon after the non-CRT proficiency threshold was reached. Electrical performance and safety outcomes remained stable throughout the learning process. Conclusions: CUSUM provides a clear, objective, and real-time measure of operator progression during the initial learning phase of LBBAP. The technique reliably identified the proficiency transition and can be readily implemented for procedural training, credentialing, and competency monitoring in centers adopting LBBAP.
Tudorancea et al. (Thu,) reported a other. Fluoroscopy time decreased with proficiency achieved after approximately 65 cases in left bundle branch area pacing, indicating successful learning curve progression.