Three ECG-only criteria, including a terminal S wave in V, were highly predictive of conduction system pacing capture in patients without prior ventricular pacing.
Cohort
No
Can ECG-only criteria reliably confirm Conduction System Pacing (CSP) capture compared to established EP system criteria in patients without prior ventricular pacing?
Simple ECG-based markers can reliably identify Conduction System Pacing capture, potentially expanding access to this pacing strategy without requiring specialized EP systems.
BACKGROUND: Conduction System Pacing (CSP) is recommended when high ventricular pacing burden is expected, and as an alternative to cardiac resynchronization. Multiple studies have demonstrated the importance of achieving CSP over deep septal pacing, with associated improved clinical outcomes. There are various currently accepted criteria to ascertain CSP lead placement, which all require an electrophysiology (EP) system. EP systems are not widely available, limiting CSP lead placement to tertiary hospitals and specialized centers. The purpose of this study was to identify ECG-only criteria capable of confirming CSP capture and thereby improve accessibility to this pacing strategy. METHODS: We retrospectively extracted all attempted CSP implantations at our centre. Established CSP criteria were assessed for each patient, alongside the presence of ECG-only features. RESULTS: The presence of three ECG-only criteria was found to be highly predictive of CSP in patients without a previously paced rhythm: terminal S wave in V CONCLUSIONS: These findings suggest that CSP capture may be reliably identified using a combination of simple ECG-based markers in patients without prior ventricular pacing. Implementation of these criteria may facilitate broader adoption of CSP by enabling reliable confirmation of capture without the need for EP systems, thereby expanding patient access to this physiologic pacing strategy.
Fakim et al. (2026) conducted a cohort in Conduction System Pacing. ECG-only criteria was evaluated on Confirmation of conduction system pacing capture. Three ECG-only criteria, including a terminal S wave in V, were highly predictive of conduction system pacing capture in patients without prior ventricular pacing.