[Left bundle branch area pacing and resynchronization in heart failure]

Left bundle branch block pacing (LBBAP) is a recent technique for capturing conduction pathways to allow physiological ventricular activation. It is technically more reliable than Hisian pacing and can correct proximal left bundle branch block. In this context, numerous registries and the first small randomized studies have evaluated the benefit of left bundle branch block pacing compared to conventional resynchronization therapy, with encouraging results in favor of LBBAP. More robust randomized studies are underway. A consensus document has included this strategy as a possible first-line option and is recommended in cases of failure of conventional resynchronization therapy. Manufacturers are developing dedicated equipment with LBBAP pacing integrated into the defibrillation lead.