Key result
Conduction system pacing offers a promising physiological alternative to biventricular pacing for electro-mechanical synchronization.
Why the study?
Biventricular pacing is limited by non-responders and anatomy, and while conduction system pacing is a promising physiological alternative, randomized trials, technical hurdles, and long-term outcome data remain limited.
Does conduction system pacing improve electro-mechanical ventricular synchronization and clinical outcomes compared to biventricular pacing in patients with heart failure and LBBB?
Does conduction system pacing improve electro-mechanical ventricular synchronization and clinical outcomes compared to biventricular pacing in patients with heart failure and LBBB?
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.
May support physiological pacing in select HF patients; leaves open its primary role pending large randomized outcome trials.
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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Bressi et al. (2023) 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.
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