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Review
. 2020 Nov;9(3):136-145.
doi: 10.15420/aer.2020.14.

His-Purkinje Conduction System Pacing: State of the Art in 2020

Ahran D Arnold  1 , Zachary I Whinnett  1 , Pugazhendhi Vijayaraman  2
Affiliations
Review

His-Purkinje Conduction System Pacing: State of the Art in 2020

Ahran D Arnold et al. Arrhythm Electrophysiol Rev. 2020 Nov.

Abstract

Conduction system pacing involves directly stimulating the specialised His-Purkinje cardiac conduction system with the aim of activating the ventricles physiologically, in contrast to the dyssynchronous activation produced by conventional myocardial pacing. Since the first report of permanent His bundle pacing (HBP) in 2000, the stylet-driven technique of its earliest incarnation has been superseded by a more successful stylet-less approach. Widespread uptake has led to a much greater evidence base. Single-centre observational studies have now been supported by large multicentre, international registries, mechanistic studies and the first randomised controlled trials. New evidence has elucidated mechanisms of HBP and illustrated the nature and magnitude of its potential benefits for preventing pacing-induced cardiomyopathy and correcting bundle branch block. Left bundle branch pacing (LBBP) is a newer technique in which the lead is fixed deep into the left side of the intraventricular septum to allow capture of the left bundle, distal to the His bundle. LBBP holds promise as a method for physiological pacing that overcomes some of the fixation, threshold and sensing challenges of HBP. In this state-of-the-art review of His-Purkinje conduction system pacing, the authors assess recent evidence and current practice and explore emerging and future directions in this rapidly evolving field.

Keywords: His bundle pacing; bundle branch block; cardiac resynchronisation therapy; conduction system pacing; deep septal pacing; left bundle area pacing; left bundle branch pacing.

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Conflict of interest statement

Disclosure: ADA has received honoraria from Medtronic. PV has received honoraria from Medtronic, Biotronik, Boston Scientific and Abbott; Research and Fellowship support from Medtronic; and patent pending for His bundle pacing delivery tool. ZIW has received honoraria from Medtronic, Boston Scientific, Micropace and Abbott. Support Statement: ADA is supported by the National Institute of Health Research Imperial Biomedical Research Centre and the British Heart Foundation Imperial Centre of Research Excellence (RE/18/4/34215). ZIW receives research funding from the British Heart Foundation, National Institute of Health Research Imperial Biomedical Research Centre and the Coronary Flow Trust.

Figures

Figure 1:
Figure 1:. Conduction System Pacing
Figure 2:
Figure 2:. Fluoroscopy of Conduction System Pacing
Figure 3:
Figure 3:. Selective His Bundle Pacing
Figure 4:
Figure 4:. Non-selective His Bundle Pacing versus Myocardial Capture
Figure 5:
Figure 5:. Left Ventricular Septal Pacing versus Left Bundle Branch Pacing
See this image and copyright information in PMC

References

    1. Ng AC, Allman C, Vidaic J et al. Long-term impact of right ventricular septal versus apical pacing on left ventricular synchrony and function in patients with second-or third-degree heart block. Am J Cardiol. 2009;103:1096–101. doi: 10.1016/j.amjcard.2008.12.02. - DOI - PubMed
    1. Arnold AD, Shun-Shin MJ, Keene D et al. His resynchronization versus biventricular pacing in patients with heart failure and left bundle branch block. J Am Coll Cardiol. 2018;72:3112–22. doi: 10.1016/j.jacc.2018.09.073. - DOI - PMC - PubMed
    1. Ali N, Keene D, Arnold A et al. His bundle pacing: a new frontier in the treatment of heart failure. Arrhythm Electrophysiol Rev. 2018;7:103–10. doi: 10.15420/aer.2018.6.2. - DOI - PMC - PubMed
    1. Verma N, Knight BP. Update in cardiac pacing. Arrhythm Electrophysiol Rev. 2019;8:228–33. doi: 10.15420/aer.2019.15.3. - DOI - PMC - PubMed
    1. Dandamudi G, Vijayaraman P. History of His bundle pacing. J Electrocardiol. 2017;50:156–60. doi: 10.1016/j.jelectrocard.2016.09.011. - DOI - PubMed