[Physiological pacing and heart failure : Hope or hype?]

The cornerstone of heart failure treatment consists of a four pillar drug therapy. Patients with existing heart failure and complete left bundle branch block, or patients with an indication for pacemaker therapy for bradycardia and heart failure, benefit from physiological stimulation. For patients with left bundle branch block and severely impaired left ventricular systolic pump function (HFrEF), cardiac resynchronisation therapy (CRT) has so far been the gold standard. However, it is now increasingly possible to stimulate the conduction system directly using new forms of stimulation and to achieve similar clinical results. At present, left bundle branch area pacing (LBBAP) is the form of stimulation most frequently investigated in clinical studies. A special situation arises in the case of pacemaker-induced cardiomyopathy with right ventricular apical pacing. Here, LBBAP is certainly a beacon of hope.