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. 2023 Apr 26;25(Suppl C):C234-C241.
doi: 10.1093/eurheartjsupp/suad047. eCollection 2023 May.

Pacing of the specialized His-Purkinje conduction system: 'back to the future'

Edoardo Bressi  1   2 , Domenico Grieco  1 , Karol Čurila  3 , Francesco Zanon  4 , Lina Marcantoni  4 , Jose Angel Cabrera  5 , Ermenegildo De Ruvo  1 , Kevin Vernooy  2 , Leonardo Calò  1
Affiliations

Pacing of the specialized His-Purkinje conduction system: 'back to the future'

Edoardo Bressi et al. Eur Heart J Suppl. .

Abstract

The conduction system of the human heart is composed of specialized cardiomyocytes that initiate and propagate the electric impulse with consequent rhythmic and synchronized contraction of the atria and ventricles, resulting in the normal cardiac cycle. Although the His-Purkinje system (HPS) was already described more than a century ago, there has been a recent resurgence of conduction system pacing (CSP), where pacing leads are positioned in the His bundle region and left bundle branch area to provide physiological cardiac activation as alternatives to the unnatural myocardial stimulation obtained with conventional right ventricular and biventricular pacing. In this review, we describe the fundamental anatomical and pathophysiological aspects of the specialized HPS along with the CSP technique's nuts and bolts to highlight its potential benefits in everyday clinical practice.

Keywords: Conduction system pacing; His-bundle pacing; His–Purkinje system; Left bundle branch area pacing; Ultra-high-frequency electrocardiogram.

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Conflict of interest statement

Conflict of interest: All authors have reported that they have no relationships relevant to the contents of this review to disclose.

Figures

Figure 1
Figure 1
(A and B) Gross dissections of the human atrioventricular conduction axis relative to the triangle of Koch, revealing the position of the atrioventricular node and the penetrating bundle relative to the hinge line of the septal leaflet of the tricuspid valve. Note the dividing line between the atrioventricular component of the membranous septum and the interventricular component of the membranous septum. The penetrating atrioventricular bundle enters the atrioventricular component of the membranous septum encircled by the fibrous tissue of the central fibrous body. (C) The left bundle branch arises between the right and non-coronary sinus. Note that we have highlighted in dark colour the limits of the endocardial position of the main trunk and its three fascicles towards the papillary muscles. CSO, coronary sinus orifice; OF, oval fossa.
Figure 2
Figure 2
An example of non-selective His-bundle pacing capture on a 12-lead electrocardiogram in a patient with baseline narrow QRS.
Figure 3
Figure 3
An example of fixation beat during lead deployment and continuous pacing-while-screwing technique. Fixations beats are premature ventricular complexes generated during lead deployment with morphology changing from QS to qR in lead V1 as the lead reaches the left bundle branch area.
See this image and copyright information in PMC

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