Conduction system pacing: Current status and prospects

• Published in: Journal of Cardiology Vol. 81; no. 5; pp. 413 - 419
• Main Authors: Togashi, Ikuko, Sato, Toshiaki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2023; Elsevier BV
• Subjects: Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy - methods; Conduction system pacing; Electrocardiography; Electrocardiography - methods; Heart Failure; Heart Failure - therapy; His bundle pacing; Humans; Left bundle branch area pacing; Left bundle branch pacing; Left ventricular septal pacing; Treatment Outcome; Ventricular Dysfunction, Left; Left ventricular septal pacing; His bundle pacing; Conduction system pacing; Left bundle branch area pacing; Left bundle branch pacing
• ISSN: 0914-5087; 1876-4738; 1876-4738
• DOI: 10.1016/j.jjcc.2023.01.011

Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), is the most physiological of all pacing modalities for ventricular capture and a potential alternative to right ventricular pacing. It induces electrical and mechanical dyssynchrony, resulting in left ventricular dysfunction, heart failure hospitalization, and atrial arrhythmia. CSP activates the normal conduction system and restores ventricular synchrony. In 2000, HBP was first performed as permanent ventricular pacing, which improved left ventricular systolic dysfunction. The feasibility of permanent HBP has already been demonstrated in patients with bradycardia, although a high capture threshold and limited efficacy for infra-Hisian conduction diseases remain critical issues. The LBBAP is an alternative pacing form that overcomes the limitations of the HBP. A lower capture threshold was obtained at implantation and preserved during the follow-up period in patients with LBBAP. Cardiac resynchronization therapy with HBP or LBBAP may provide better synchronization than the traditional biventricular pacing. Hybrid therapy utilizing HBP or LBBAP in combination with left ventricular pacing has been introduced to treat patients with heart failure. In this review, we have focused on the clinical implications, limitations, and a literature review on CSP. [Display omitted] •His-Purkinje conduction system pacing is expected to induce physiological left ventricular activation.•Conduction system pacing has demonstrated favor outcome, compared with right ventricular pacing in observational studies.•Conduction system pacing may provide better cardiac resynchronization therapy than traditional biventricular pacing.