Conduction System Pacing for Cardiac Resynchronization Therapy in Heart Failure with Reduced Ejection Fraction

Most patients with heart failure exhibit ventricular dyssynchrony, which is addressed by cardiac resynchronization therapy, traditionally through the use of biventricular pacing (BVP) devices. Despite this, around 30% of patients do not achieve the desired clinical outcome, and echocardiographic findings show that some patients deteriorate even further. Conduction system pacing (CSP) is a more physiologic pacing technique and includes his-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). In this review, we further discuss and compare various CSP techniques for cardiac resynchronization therapy in patients with heart failure with reduced ejection fraction. After analyzing the current state of the literature on this topic until 2023, eight studies were included in this review and consisted of two trials and five observational studies with a total of 2841 patients. Both BVP and CSP resulted in improved outcomes in terms of NYHA class, QRS duration, and left ventricular ejection fraction over time. These effects were more pronounced in patients undergoing CSP, as the technique is more physiological and results in the synchronized activation of the ventricles. LBBAP yielded better outcomes compared to BVP and resulted in fewer heart failure hospitalizations and a lower all-cause mortality rate.