Key result
Conduction system pacing preserves intrinsic activation and may become the new CRT standard in advanced HF.
Why the study?
Conduction system pacing has emerged as a physiological alternative to classical biventricular pacing, prompting the need for an overview of technical aspects and clinical evidence.
Does conduction system pacing improve outcomes compared to classical biventricular pacing in patients with advanced heart failure requiring cardiac resynchronization therapy?
Does conduction system pacing improve outcomes compared to classical biventricular pacing in patients with advanced heart failure requiring cardiac resynchronization therapy?
Conduction system pacing is a promising emerging alternative to classical biventricular pacing for cardiac resynchronization therapy, though large randomized trials are still needed to establish it as the new gold standard.
Should not yet replace biventricular pacing; leaves open conduction system pacing as new standard pending randomized trials.
The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) has emerged as a variant for advanced cardiac device therapy. It provides pacing with preserved intrinsic cardiac activation by direct stimulation of the specific cardiac conduction system. The term CSP integrates the modalities of HIS bundle pacing (HBP) and left bundle branch area pacing (LBBAP), both of which have provided convincing data in smaller randomized and big non-randomized studies for the prevention of pacemaker-induced cardiomyopathy and for providing effective cardiac resynchronization therapy in patients with classical CRT-indication (primary approach or after failed CRT). Recent American guidelines proposed the term "cardiac physiological pacing" (CPP), which summarizes CSP including left ventricular septal pacing (LVSP), a technical variant of LBBAP together with classical BiV-CRT. The terms HOT-CRT (HIS-optimized CRT) and LOT-CRT (LBBP-optimized CRT) describe hybrid technologies that combine CSP with an additional coronary-sinus electrode, which is sometimes useful in patients with advanced HF and diffuse interventricular conduction delay. If CSP continues providing promising data that can be confirmed in big, randomized trials, it is likely to become the new gold standard for patients with an expected high percentage of pacing (>20%), possibly also for cardiac resynchronization therapy. CSP is a sophisticated new treatment option that has the potential to raise the term "cardiac resynchronization therapy" to a new level. The aim of this review is to provide basic technical, anatomical, and functional knowledge of these new pacemaker techniques in order to facilitate the understanding of the different modalities, as well as to provide an up-to-date overview of the existing randomized and non-randomized evidence, particularly in direct comparison to right ventricular and classical biventricular pacing.
No takes yet. Share an insight, caveat, or question.
Derndorfer et al. (2024) conducted a review in Advanced heart failure. Conduction system pacing (CSP) vs. Classical biventricular pacing (BiV-CRT) was evaluated. Conduction system pacing provides pacing with preserved intrinsic cardiac activation and has the potential to become the new gold standard for cardiac resynchronization therapy in advanced heart failure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: