Patient Selection for Biventricular Cardiac Resynchronization Therapy, His Bundle Pacing, and Left Bundle Branch Pacing

• Published in: Current cardiovascular risk reports Vol. 15; no. 11; p. 22
• Main Authors: Sanders, David J., Krishnan, Kousik
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2021; Springer Nature B.V
• Subjects: Ablation; Arrhythmias (J. Bunch; Artificial intelligence; Cardiac arrhythmia; Cardiology; Cardiomyopathy; Clinical outcomes; Ejection fraction; Electrocardiography; Heart failure; Hemodynamics; Ischemia; Machine learning; Medicine; Medicine & Public Health; Morphology; Mortality; Pacemakers; Patients; Section Editor; Topical Collection on Arrythmias; Transplants & implants; United States > US; Biventricular cardiac resynchronization therapy; Heart failure with reduced ejection fraction; His bundle pacing; Bradyarrhythmia; Left bundle branch pacing
• ISSN: 1932-9520; 1932-9563
• DOI: 10.1007/s12170-021-00684-6

Purpose of Review His bundle pacing (HBP) and left bundle branch pacing (LBBP) offer physiologic activation of the conduction system and their use is expanding. But choosing the best modality for an individual clinical scenario remains challenging. We review the evidence supporting HBP, LBBP, and traditional biventricular cardiac resynchronization therapy (BiV CRT), and relate this to appropriate patient selection. Recent Findings Traditional BiV CRT has been established as effective in certain patients but is limited by a high rate of non-response. More precise ECG analysis and prognostic models that incorporate echocardiographic and clinical parameters will help predict which patients will respond to therapy. HBP has been shown to be safe and feasible for a range of bradyarrhythmias and as an alternative to BiV CRT. Short-term clinical outcomes are promising. This modality is limited, however, by its technically challenging implant, inability to correct distal conduction system disease, and occasionally high pacing thresholds. LBBP was developed to bypass some of HBP’s shortcomings. It too has been shown to be safe and feasible, while lead implant is technically easier and pacing is effective at low thresholds. Clinical outcomes with LBBP have yet to be examined. Summary Traditional BiV CRT remains an important pacing technique for patients with systolic dysfunction and more detailed prognostic models will refine patient selection. HBP and LBBP show great potential for the spectrum of pacing indications and their use will likely expand as data on clinical outcomes accumulate.