Physiological pacing: mechanisms, clinical indications, and perspectives

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Normal cardiac function relies on an efficient conduction system.
• Conduction system disease impairs cardiac function, causing symptoms like fatigue, breathlessness, syncope, and potentially death.
• Traditional pacemakers treat bradycardia but can cause non-physiological ventricular activation, reducing cardiac performance.

Purpose of the Study:

• To review the evolution of physiological pacing techniques.
• To highlight advancements in preserving or restoring normal ventricular activation patterns.
• To discuss the potential benefits and expanded indications of modern pacing strategies.

Main Methods:

• Review of historical and recent developments in cardiac pacing.
• Examination of various physiological pacing approaches, including His-bundle pacing and left bundle branch pacing.
• Analysis of the impact of pacing on cardiac function and activation patterns.

Main Results:

• Right ventricular pacing leads to non-physiological myocardial activation.
• Newer techniques focus on preserving physiological activation, such as atrio-biventricular pacing and conduction system pacing.
• These advanced methods may reduce adverse pacing effects and expand treatment indications.

Conclusions:

• Physiological pacing represents a significant advancement over traditional methods.
• Conduction system pacing techniques offer a more natural approach to cardiac rhythm management.
• Adoption of these techniques could improve patient outcomes and broaden the scope of pacing therapy.