Primer of conduction system pacing for the general cardiologist

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Right ventricular pacing can cause heart dysfunction and increase mortality.
• Traditional biventricular CRT has limitations in efficacy and physiological activation.
• Conduction system pacing (CSP) aims to restore physiological activation via the His-Purkinje system.

Purpose of the Study:

• To provide a practical overview of CSP for cardiologists.
• To review the rationale, techniques, and clinical evidence for CSP.
• To guide patient selection, follow-up, and future research in CSP.

Main Methods:

• Review of key clinical trials and real-world outcomes of CSP.
• Summarization of techniques for His bundle pacing and left bundle branch area pacing.
• Inclusion of clinical pearls and tables for practical insights.

Main Results:

• CSP represents a paradigm shift in managing bradycardia and heart failure with reduced ejection fraction (HFrEF).
• CSP seeks to achieve more consistent and physiological resynchronisation compared to traditional CRT.
• Evidence from trials and real-world data supports the use of CSP.

Conclusions:

• CSP offers a promising alternative to traditional pacing methods.
• Physiological activation through CSP may improve outcomes in patients with pacing indications and HFrEF.
• Further research and clinical experience will refine CSP techniques and patient selection.