Key result
His-Purkinje conduction system pacing provides a physiological alternative to conventional pacing to prevent PICM.
Why the study?
Recent evidence from large registries, mechanistic studies, and randomized trials has expanded the evidence base for His bundle pacing and left bundle branch pacing, prompting an assessment of recent evidence, current practice, and future directions.
This state-of-the-art review highlights the evolution and emerging evidence for His-Purkinje conduction system pacing as a physiological alternative to conventional pacing.
May support physiological pacing strategies to avert cardiomyopathy; leaves open need for randomized confirmation before broad adoption.
Conduction system pacing involves directly stimulating the specialised His-Purkinje cardiac conduction system with the aim of activating the ventricles physiologically, in contrast to the dyssynchronous activation produced by conventional myocardial pacing. Since the first report of permanent His bundle pacing (HBP) in 2000, the stylet-driven technique of its earliest incarnation has been superseded by a more successful stylet-less approach. Widespread uptake has led to a much greater evidence base. Single-centre observational studies have now been supported by large multicentre, international registries, mechanistic studies and the first randomised controlled trials. New evidence has elucidated mechanisms of HBP and illustrated the nature and magnitude of its potential benefits for preventing pacing-induced cardiomyopathy and correcting bundle branch block. Left bundle branch pacing (LBBP) is a newer technique in which the lead is fixed deep into the left side of the intraventricular septum to allow capture of the left bundle, distal to the His bundle. LBBP holds promise as a method for physiological pacing that overcomes some of the fixation, threshold and sensing challenges of HBP. In this state-of-the-art review of His-Purkinje conduction system pacing, the authors assess recent evidence and current practice and explore emerging and future directions in this rapidly evolving field.
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Arnold et al. (2020) conducted a review in Bradycardia, bundle branch block, and heart failure requiring pacing. His-Purkinje Conduction System Pacing (His bundle pacing and left bundle branch pacing) vs. Conventional myocardial pacing (Right ventricular pacing, Biventricular pacing) was evaluated. His-Purkinje conduction system pacing, including His bundle and left bundle branch pacing, provides a physiological alternative to conventional myocardial pacing to prevent pacing-induced cardiomyopathy.
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