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Optimal pace timing for left bundle branch area pacing with or without an additional LV lead: results from the CSPOT study.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology·2026
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Current Role of Conduction System Pacing in Patients Requiring Permanent Pacing.

Dominik Beer1, Pugazhendhi Vijayaraman2

  • 1Geisinger Heart Institute, Danville, PA, USA.

Korean Circulation Journal
|June 11, 2024
PubMed
Summary

Conduction system pacing, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), offers a more synchronous ventricular contraction by utilizing the heart's native electrical system. This review examines the promising emergence and current role of these novel pacing methods.

Keywords:
Cardiac pacingCardiac resynchronization therapyConduction system pacingHis bundle pacingLeft bundle branch area pacing

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • His bundle pacing (HBP) and left bundle branch pacing (LBBP) are emerging techniques for cardiac pacing.
  • These methods directly target the cardiac conduction system, unlike traditional pacing.
  • Conduction system pacing leverages the heart's intrinsic electrical pathways for impulse dissemination.

Purpose of the Study:

  • To review the development and current clinical applications of conduction system pacing.
  • To discuss the advantages of His bundle pacing and left bundle branch pacing in permanent cardiac pacing.
  • To highlight the promising data emerging from observational studies and early clinical trials.

Main Methods:

  • Review of existing literature on His bundle pacing and left bundle branch pacing.
  • Analysis of observational data, registries, and early randomized controlled trials.
  • Synthesis of information on the contemporary role of conduction system pacing.

Main Results:

  • Conduction system pacing promotes a more synchronous ventricular contraction compared to conventional methods.
  • His bundle pacing, though developed earlier, has recently gained clinical traction.
  • Available data from registries and trials suggest promising outcomes for conduction system pacing.

Conclusions:

  • Conduction system pacing, encompassing HBP and LBBP, represents a significant advancement in cardiac pacing.
  • These techniques utilize the native cardiac conduction system for improved electrical impulse spread.
  • While further research is ongoing, current evidence indicates a promising future for conduction system pacing in clinical practice.