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Review
. 2023 Sep 29;12(19):6288.
doi: 10.3390/jcm12196288.

Conduction System Pacing versus Conventional Biventricular Pacing for Cardiac Resynchronization Therapy: Where Are We Heading?

Giulia Domenichini  1 , Mathieu Le Bloa  1 , Cheryl Teres Castillo  1 , Denis Graf  1 , Patrice Carroz  1 , Ciro Ascione  1 , Alessandra Pia Porretta  1 , Patrizio Pascale  1 , Etienne Pruvot  1
Affiliations
Review

Conduction System Pacing versus Conventional Biventricular Pacing for Cardiac Resynchronization Therapy: Where Are We Heading?

Giulia Domenichini et al. J Clin Med. .

Abstract

Over the last few years, pacing of the conduction system (CSP) has emerged as the new standard pacing modality for bradycardia indications, allowing a more physiological ventricular activation compared to conventional right ventricular pacing. CSP has also emerged as an alternative modality to conventional biventricular pacing for the delivery of cardiac resynchronization therapy (CRT) in heart failure patients. However, if the initial clinical data seem to support this new physiological-based approach to CRT, the lack of large randomized studies confirming these preliminary results prevents CSP from being used routinely in clinical practice. Furthermore, concerns are still present regarding the long-term performance of pacing leads when employed for CSP, as well as their extractability. In this review article, we provide the state-of-the-art of CSP as an alternative to biventricular pacing for CRT delivery in heart failure patients. In particular, we describe the physiological concepts supporting this approach and we discuss the future perspectives of CSP in this context according to the implant techniques (His bundle pacing and left bundle branch area pacing) and the clinical data published so far.

Keywords: biventricular pacing; cardiac resynchronization therapy; conduction system pacing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CRT implant techniques (standard biventricular pacing and conduction system pacing): anatomical differences, advantages, and limitations. Abbreviations: AV: atrioventricular; BiV: biventricular; CRT: cardiac resynchronization therapy; CSP: conduction system pacing; HBP: His bundle pacing; HOT-CRT: His optimized-cardiac resynchronization therapy; ICD: implantable cardioverter defibrillator; LA: left anterior; LBB: left bundle branch; LBBAP: left bundle branch area pacing; LF: left fascicular; LS: left mid-septal; LOT-CRT: left bundle branch area pacing optimized-cardiac resynchronization therapy; LP: left posterior; LV: left ventricular; LVS: left ventricular septal; RV: right ventricular; VV: interventricular.
Figure 2
Figure 2
Decision tree to guide the strategy for cardiac resynchronization therapy (CRT) implants in heart failure patients according to the patient’s clinical characteristics and the different implant techniques. Abbreviations: BBB: bundle branch block; BiV: biventricular; CSP: conduction system pacing; HF: heart failure; HBP: His bundle pacing; HOT-CRT: His optimized-cardiac resynchronization therapy; IVCD: intraventricular conduction delay; LBBAP: left bundle branch area pacing; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LOT-CRT: left bundle branch area pacing optimized-cardiac resynchronization therapy; RBBB: right bundle branch block; VP: ventricular pacing.
See this image and copyright information in PMC

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