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Volume 15
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10.3390/jcm15010335
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

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

by
Ionuț Tudorancea
1,2,
Mihai Ștefan Cristian Haba
1,2,*,
Mircea Cristian Placinta
1,
Irene Paula Popa
1,
Emil Gabriel Calistrat
2,
Alexandru Guila
2,
Daniela Crișu
2,
Viviana Onofrei
1,2,
Dragomir Nicolae Șerban
1,
Ionela Lăcrămioara Șerban
1,
Radu Iliescu
1,3 and
Irina Iuliana Costache Enache
1,2
1
Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
2
Cardiology Clinic, “Saint Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
3
Transcend Research Centre, 2-4 General Henri Mathias Berthelot Street, 700483 Iaşi, Romania
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(1), 335; https://doi.org/10.3390/jcm15010335 (registering DOI)
Submission received: 16 November 2025 / Revised: 11 December 2025 / Accepted: 20 December 2025 / Published: 1 January 2026
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
Versions Notes

Abstract

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.
Keywords: left bundle branch pacing; conduction system pacing; cumulative sum (CUSUM) analysis; learning curve; operator training; cardiac resynchronization therapy left bundle branch pacing; conduction system pacing; cumulative sum (CUSUM) analysis; learning curve; operator training; cardiac resynchronization therapy

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MDPI and ACS Style

Tudorancea, I.; Haba, M.Ș.C.; Placinta, M.C.; Popa, I.P.; Calistrat, E.G.; Guila, A.; Crișu, D.; Onofrei, V.; Șerban, D.N.; Șerban, I.L.; et al. CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing. J. Clin. Med. 2026, 15, 335. https://doi.org/10.3390/jcm15010335

AMA Style

Tudorancea I, Haba MȘC, Placinta MC, Popa IP, Calistrat EG, Guila A, Crișu D, Onofrei V, Șerban DN, Șerban IL, et al. CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing. Journal of Clinical Medicine. 2026; 15(1):335. https://doi.org/10.3390/jcm15010335

Chicago/Turabian Style

Tudorancea, Ionuț, Mihai Ștefan Cristian Haba, Mircea Cristian Placinta, Irene Paula Popa, Emil Gabriel Calistrat, Alexandru Guila, Daniela Crișu, Viviana Onofrei, Dragomir Nicolae Șerban, Ionela Lăcrămioara Șerban, and et al. 2026. "CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing" Journal of Clinical Medicine 15, no. 1: 335. https://doi.org/10.3390/jcm15010335

APA Style

Tudorancea, I., Haba, M. Ș. C., Placinta, M. C., Popa, I. P., Calistrat, E. G., Guila, A., Crișu, D., Onofrei, V., Șerban, D. N., Șerban, I. L., Iliescu, R., & Enache, I. I. C. (2026). CUSUM Analysis as a Predictive Tool for the Learning Curve in Left Bundle Branch Area Pacing. Journal of Clinical Medicine, 15(1), 335. https://doi.org/10.3390/jcm15010335

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