Key result
Conduction system pacing emerges as a safe physiological alternative to RVP and BiV pacing.
Why the study?
Conduction system pacing is increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing, prompting a need to discuss its current evidence, indications, and remaining challenges.
Does conduction system pacing improve clinical outcomes compared to right ventricular or biventricular pacing in patients requiring cardiac stimulation?
Does conduction system pacing improve clinical outcomes compared to right ventricular or biventricular pacing in patients requiring cardiac stimulation?
Conduction system pacing is a promising physiological alternative to traditional pacing, but requires further validation from large randomized trials to establish its definitive role in guidelines.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Because randomized controlled trials on HBP are currently lacking, cardiologists should be very careful when choosing HBP over CRT in these heart failure patients. Before recommending HBP as an opportunity to reduce TR in patients needing CRT, prospective randomized clinical trials are needed to evaluate whether HBP is equal to or better than conventional CRT in patients with heart failure.”
“Even though CSP is theoretically an alternative for BV pacing, the implantation requires new skills and knowledge with limited success rates in patients with heart failure with the current tools. Therefore, we still need BV as a bail-out strategy, so I think we should not go too quickly.”
“The only time BV-CRT may be a better fit is when there is no HIS-Purkinje disruption at all.”
Conduction system pacing warrants cautious use by experienced operators only; leaves open its guideline role pending consistent randomized evidence.
Conduction system pacing is a major milestone in cardiac stimulation and is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. This expert viewpoint discusses the current evidence, indications and remaining challenges of this promising therapy.
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Burri et al. (2026) conducted a review in Patients requiring cardiac pacing (atrioventricular block, heart failure, bundle branch block). Conduction system pacing (His bundle pacing and left bundle branch area pacing) vs. Right ventricular pacing or biventricular pacing was evaluated. Conduction system pacing is emerging as a physiological alternative to right ventricular and biventricular pacing, with growing evidence of safety and efficacy.
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