Conduction system pacing, including His bundle pacing and left bundle area pacing, provides a physiological alternative to conventional cardiac resynchronization therapy for patients with heart failure.
Does conduction system pacing (His bundle pacing or left bundle area pacing) improve physiological ventricular activation and clinical outcomes compared to conventional pacing or CRT in patients with heart failure?
Conduction system pacing (HBP and LBAP) offers a more physiological alternative to conventional right ventricular and biventricular pacing for heart failure patients, though large randomized trials are still needed to validate long-term outcomes.
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used instead of conventional pacemakers. Both HBP and LBBP are being investigated as alternatives to conventional CRT.
Tun et al. (Tue,) conducted a review in Heart failure. Conduction system pacing (His bundle pacing and left bundle area pacing) vs. Conventional cardiac resynchronization therapy (CRT) or right ventricular pacing was evaluated. Conduction system pacing, including His bundle pacing and left bundle area pacing, provides a physiological alternative to conventional cardiac resynchronization therapy for patients with heart failure.