Conduction system pacing for cardiac resynchronization therapy: a systematic review

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Biventricular pacing (BVP) is the standard for cardiac resynchronization therapy (CRT) in heart failure (HF) with left bundle branch block (LBBB).
• BVP is non-physiological and faces limitations like coronary sinus access issues and patient non-response.
• Conduction system pacing (CSP), including His bundle pacing (HBP) and Left Bundle Branch area pacing (LBBAP), is an emerging, more physiological alternative.

Purpose of the Study:

• To systematically review the existing literature on CSP for CRT.
• To explore CSP's potential applications in various clinical scenarios.
• To discuss current controversies and future directions for CSP in CRT.

Main Methods:

• Systematic literature review of studies on CSP for CRT.
• Analysis of early studies comparing CSP with BVP regarding electro-mechanical synchrony.
• Discussion of procedural challenges and long-term outcome data.

Main Results:

• Early studies suggest CSP may provide superior ventricular synchrony compared to BVP.
• CSP is considered a more physiological pacing strategy for CRT.
• Significant limitations include scarce large-scale randomized controlled trial data and procedural complexities.

Conclusions:

• CSP presents a promising, physiological alternative to BVP for CRT.
• Further large-scale randomized trials are necessary to establish CSP's long-term efficacy and safety.
• CSP cannot yet replace BVP as the first-line CRT strategy due to insufficient evidence and practical challenges.