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

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Ventricular dyssynchrony affects most heart failure patients, often treated with biventricular pacing (BVP).
• A significant portion of patients (around 30%) show suboptimal response or even deterioration with BVP.
• Conduction system pacing (CSP), including his-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), presents a more physiologic alternative.

Purpose of the Study:

• To review and compare various CSP techniques for cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction (HFrEF).
• To analyze the efficacy of CSP versus traditional BVP based on current literature up to 2023.

Main Methods:

• Systematic review of literature published until 2023.
• Inclusion of eight studies: two trials and five observational studies.
• Total patient cohort of 2841 individuals.

Main Results:

• Both BVP and CSP improved outcomes, including NYHA class, QRS duration, and left ventricular ejection fraction.
• CSP demonstrated more pronounced improvements due to its physiologic nature and synchronized ventricular activation.
• Left bundle branch area pacing (LBBAP) showed superior results compared to BVP, with reduced heart failure hospitalizations and all-cause mortality.

Conclusions:

• Conduction system pacing is an effective CRT strategy for HFrEF patients.
• Left bundle branch area pacing offers significant advantages over traditional BVP, improving clinical outcomes and survival.
• CSP represents a promising advancement in CRT for heart failure management.