What is the clinical evidence from this study?

Study design: Review. Population: Heart failure with left bundle branch block requiring cardiac resynchronization therapy. Intervention: Conduction system pacing (His bundle pacing and Left bundle branch area pacing) vs. Biventricular pacing (BVP).

January 13, 2023Open Access

Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives

Key Result

Conduction system pacing provides a physiological alternative to biventricular pacing with promising electro-mechanical synchronization, though large randomized trials are needed to confirm long-term clinical outcomes.

Structured PICO

Does conduction system pacing improve electro-mechanical ventricular synchronization and clinical outcomes compared to biventricular pacing in patients with heart failure and LBBB?

Population

Patients with heart failure (HF) and left bundle branch block (LBBB) who are candidates for cardiac resynchronization therapy (CRT)

Intervention

Conduction system pacing (CSP), including His bundle pacing (HBP) and Left bundle branch area pacing (LBBAP)

Comparator

Conventional biventricular pacing (BVP)

Outcome

Electro-mechanical ventricular synchronization and long-term clinical outcomes

Conduction system pacing is a promising physiological alternative to biventricular pacing for cardiac resynchronization therapy, but more long-term randomized data are needed to establish its primary role.

Limitations

Technical challenges and high pacing thresholds with His bundle pacing
Lack of long-term safety and clinical outcome data for left bundle branch area pacing
Potential risks of lead perforation and unknown feasibility of lead extraction
Most studies conducted in non-ischemic cardiomyopathy, limiting generalizability to ischemic substrates

Abstract

Biventricular pacing (BVP) is the established treatment to perform cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and left bundle branch block (LBBB). However, BVP is an unnatural pacing modality still conditioned by the high percentage of non-responders and coronary sinus anatomy. Conduction system pacing (CSP)-His bundle pacing (HBP) and Left bundle branch area pacing (LBBAP)- upcomes as the physiological alternative to BVP in the quest for the optimal CRT. CSP showed promising results in terms of better electro-mechanical ventricular synchronization compared to BVP. However, only a few randomized control trials are currently available, and technical challenges, along with the lack of information on long-term clinical outcomes, limit the establishment of a primary role for CSP over conventional BVP in CRT candidates. This review provides a comprehensive literature revision of potential applications of CSP for CRT in diverse clinical scenarios, underlining the current controversies and prospects of this technique.

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Cite This Study

Bressi et al. (Fri,) conducted a review in Heart failure with left bundle branch block requiring cardiac resynchronization therapy. Conduction system pacing (His bundle pacing and Left bundle branch area pacing) vs. Biventricular pacing (BVP) was evaluated. Conduction system pacing provides a physiological alternative to biventricular pacing with promising electro-mechanical synchronization, though large randomized trials are needed to confirm long-term clinical outcomes.

synapsesocial.com/papers/6a0ef652aa1655e5fb23114a https://doi.org/https://doi.org/10.3389/fphys.2023.1124195

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