Conduction system pacing is an experimental physiologic alternative to conventional cardiac resynchronization therapy that may improve electrical resynchronization and echocardiographic response.
Systematic Review
Does conduction system pacing improve electrical resynchronization and echocardiographic response compared to conventional bi-ventricular pacing in patients with chronic systolic heart failure and conduction system disease?
Conduction system pacing represents an intriguing, experimental physiologic alternative to conventional biventricular pacing for cardiac resynchronization therapy.
In chronic systolic heart failure and conduction system disease, cardiac resynchronization therapy (CRT) is the only known non-pharmacologic heart failure therapy that improves cardiac function, functional capacity, and survival while decreasing cardiac workload and hospitalization rates. While conventional bi-ventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional CRT evolve around myocardial scar, fibrosis, and inability to effectively simulate diseased tissue. Studies have shown endocardial stimulation in closer proximity to the specialized conduction system is more effective when compared with epicardial stimulation. Several observational and acute haemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing (CSP). Our objective is to provide a systematic review of the evolution of CRT, and an introduction to CSP as an intriguing, though experimental physiologic alternative to conventional CRT.
Herweg et al. (Sun,) conducted a systematic review in Chronic systolic heart failure and conduction system disease. Conduction system pacing (CSP) vs. Conventional cardiac resynchronization therapy (CRT) was evaluated. Conduction system pacing is an experimental physiologic alternative to conventional cardiac resynchronization therapy that may improve electrical resynchronization and echocardiographic response.