Bridging the gap: optimizing conduction system pacing for cost-effectiveness and widespread adoption in low-resource...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Right ventricular apical (RVA) pacing can cause interventricular dyssynchrony and cardiomyopathy.
• Conduction system pacing (CSP), especially Left Bundle Branch Area Pacing, presents a physiological alternative.
• Limited Resource Countries (LRCs) face challenges in Cardiac Resynchronization Therapy (CRT) adoption due to cost and operator expertise.

Purpose of the Study:

• To present CSP as a sustainable and cost-effective physiological pacing strategy.
• To enhance access to advanced arrhythmia management in resource-constrained environments.
• To share clinical experience and updates on CSP implementation.

Main Methods:

• Review of minimalist protocols and CSP-based CRT implementation.
• Exploration of scalability strategies: specialized training, device reprocessing, and regional registries.
• Addressing infrastructure gaps in resource-limited settings.

Main Results:

• CSP-based CRT significantly reduces device costs (nearly 50%) compared to traditional systems.
• This method effectively mitigates hemodynamic risks of RVA pacing.
• CSP bypasses technical and financial barriers of conventional CRT.

Conclusions:

• CSP-based CRT is a viable, cost-effective solution for advanced pacing in LRCs.
• Overcoming infrastructure challenges like remote monitoring is crucial for wider adoption.
• Standardized training and data collection are essential for optimizing outcomes and ensuring equitable access.