Conduction system pacing in the Italian clinical practice: results of a nationwide survey.

BACKGROUND: Conduction system pacing (CSP) is an increasingly used approach for physiological ventricular pacing. We conducted a nationwide survey aimed to evaluate the adoption of CSP in the Italian clinical practice. METHODS: An online survey consisting of 20 questions, distributed to Italian centres performing cardiac pacing, was conducted from October to November 2024. RESULTS: A total of 136 centres took part in the survey (37% of all arrhythmia centres operating in Italy), 119 of which (86%) declared to perform CSP implants. The lack of trained operators was the main perceived barrier to CSP adoption, reported by 58% of the centres that did not perform CSP implants. Forty-seven percent of the centres had started performing CSP implants within the last 2 years. Sixty-three percent of the operators declared to be independent in CSP implant procedures, however, 45% of them still had little experience, having performed ≤10 procedures. The median rate of pacemakers (PMs) with CSP on the total PMs implanted per year was 10%. Left bundle branch area pacing (LBBAP) was the pacing strategy used in 98% of CSP implants. The main indication for CSP implantation was atrioventricular block (46%), followed by cardiac resynchronisation therapy (17%), ablate and pace (15%), and upgrading (14%). CONCLUSIONS: CSP appears to be widely used in the Italian clinical practice, although most centres have only begun adopting it in the past few years, and many operators are still not very experienced. LBBAP is the CSP strategy most commonly chosen by the Italian operators.