Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar;28(2):379-386.
doi: 10.1007/s10741-023-10296-4. Epub 2023 Feb 14.

Conduction system pacing: promoting the physiology to prevent heart failure

Han Naung Tun  1 , Hafiza Khan  2 , Daryna Chernikova  3 , Yury Mareev  4   5 , Santabhanu Chakrabarti  6 , May Thant  7 , Antonio Cannata  8
Affiliations
Review

Conduction system pacing: promoting the physiology to prevent heart failure

Han Naung Tun et al. Heart Fail Rev. 2023 Mar.

Abstract

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.

Keywords: Cardiac resynchronization; Heart failure; His bundle pacing; Left bundle area pacing.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Advantages and disadvantage of His bundle pacing (HBP) vs left bundle branch pacing (LBBP)
Fig. 2
Fig. 2
His bundle pacing in CHF
See this image and copyright information in PMC

References

    1. Kawashima T, Sasaki H. A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat. 2005;27(3):206–213. doi: 10.1007/s00276-004-0302-7. - DOI - PubMed
    1. Arora V, Suri P. Physiological pacing: a new road to future. Indian J Clin Cardiol. 2021;2(1):32–43. doi: 10.1177/2632463620978045. - DOI
    1. Vijayaraman P, Dandamudi G (2016) Anatomical approach to permanent His bundle pacing: optimizing His bundle capture. J Electrocardiol 49(5):649–57.10.1016/j.jelectrocard.2016.07.003 - PubMed
    1. Ponnusamy SS. A road to physiological pacing. Indian J Clin Cardiol. 2021;2(1):7–9. doi: 10.1177/26324636211001585. - DOI
    1. Padala SK, Master VM, Terricabras M, Chiocchini A, Garg A, Kron J, Shepard R, et al. Initial experience, safety, and feasibility of left bundle branch area pacing: a multicenter prospective study. JACC Clin Electrophysiol. 2020;6(14):1773–1782. doi: 10.1016/j.jacep.2020.07.004. - DOI - PubMed