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Conduction system pacing: overview, definitions, and nomenclature
Marek Jastrzebski1, Gopi Dandamudi2, Haran Burri3
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland.
Insights
Conduction system pacing offers a more physiologic alternative to traditional right ventricular pacing, potentially reducing heart failure risks. Further trials are needed to confirm its benefits for bradycardia and heart failure pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Right ventricular apical pacing is linked to adverse outcomes, including heart failure, increased mortality, and reduced quality of life.
- Conduction system pacing is emerging as a promising alternative to conventional pacing methods.
Purpose of the Study:
- To review the clinical outcomes of conduction system pacing in various settings.
- To illustrate the anatomical targets and electrocardiographic findings associated with conduction system pacing.
Main Methods:
- Review of clinical results from studies investigating conduction system pacing.
- Illustration of anatomical pacing targets.
- Definition of electrocardiographic correlates for different pacing sites.
Main Results:
- Conduction system pacing, particularly from the His bundle and left bundle branch area, promotes physiologic ventricular activation.
- It is being explored as an alternative for both bradycardia and heart failure pacing.
Conclusions:
- Conduction system pacing shows potential as an alternative to right ventricular apical pacing and coronary sinus pacing.
- Comparative clinical trials are essential to establish the definitive benefits and risks of conduction system pacing versus standard techniques.
Abstract:
Pacing from the right ventricle is associated with an increased risk of development of congestive heart failure, increases in total and cardiac mortality, and a worsened quality of life. Conduction system pacing has become increasingly realized as an alternative to right ventricular apical pacing. Conduction system pacing from the His bundle and left bundle branch area has been shown to provide physiologic activation of the ventricle and may be an alternative to coronary sinus pacing. Conduction system pacing has been studied as an alternative for both bradycardia pacing and for heart failure pacing. In this review, we summarize the clinical results of conduction system pacing under a variety of different clinical settings. The anatomic targets of conduction system pacing are illustrated, and electrocardiographic correlates of pacing from different sites in the conduction system are defined. Ultimately, clinical trials comparing conduction system pacing with standard right ventricular apical pacing and cardiac resynchronization therapy pacing will help define its benefit and risks compared with existing techniques.
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