The advantages of physiological pacing.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Conventional right ventricular pacing is linked to cardiomyopathy and heart failure.
• There's a need for alternative pacing methods to improve patient outcomes.

Purpose of the Study:

• To evaluate conduction system pacing (CSP) as a physiological alternative to conventional pacing.
• To compare His bundle pacing and left bundle branch area pacing (LBBAP) for patients with reduced ejection fraction and dyssynchrony.

Main Methods:

• Review of His bundle pacing and LBBAP techniques, their advantages, disadvantages, and electrical parameters.
• Analysis of patient selection criteria, operator learning curves, and complication rates.
• Consideration of current European Society of Cardiology (ESC) guidelines regarding CSP.

Main Results:

• His bundle pacing achieves a native QRS complex but is technically challenging.
• LBBAP is technically simpler but associated with mechanical complications and wider QRS.
• CSP is safe and effective with careful patient selection and training, despite a higher complication rate than conventional pacing.

Conclusions:

• Conduction system pacing, including His bundle pacing and LBBAP, offers physiological pacing benefits.
• Current guidelines recommend CSP in specific scenarios, such as failure of resynchronization therapy or for patients with AV block and reduced ejection fraction.
• Further research is needed to fully define the role of CSP in cardiac pacing.