Transitioning into the new era of conduction system pacing (CSP): a district general hospital experience

Conduction system pacing (CSP) - encompassing His-bundle pacing (HBP) and left bundle-branch area pacing (LBBAP) - delivers more physiological ventricular pacing compared with traditional right ventricular (RV) pacing. It is gaining traction beyond tertiary centres, however, evidence from district general hospitals (DGHs) remains limited. We aimed to evaluate the feasibility, electrical performance, and early clinical outcomes of CSP implemented in a UK DGH. We performed a retrospective single-centre study of consecutive patients who underwent successful CSP at Chesterfield Royal Hospital. HBP implants (n=20) were performed between June 2019 and August 2022; LBBAP implants (n=71) between January 2023 and May 2025. Baseline demographics, procedural metrics, pacing parameters, complications, heart-failure (HF) readmissions, and echocardiographic data to 12 months were obtained from electronic records. Ninety-one patients (mean age 76 ± 10 years; 69% male) received CSP, most commonly for left ventricular systolic dysfunction (LVSD) (40%) or anticipated high right-ventricular pacing burden (42%). LBBAP demonstrated lower implant thresholds than HBP (0.92 ± 0.44 V vs. 1.50 ± 0.77 V) and remained stable to 12 months (0.68 ± 0.25 V). HBP thresholds rose to 2.11 ± 1.49 V at 12 months. Screening time was shorter with LBBAP (9.6 ± 5.9 min) than HBP (14.4 ± 6.8 min, p<0.01). No infections or septal haematomas occurred. Lead revision was required in two HBP recipients and none with LBBAP (hazard ratio 17.14, p=0.067). Nine patients (9.9%) were readmitted with HF, occurring between 56 and 1,500 days post-implant. In conclusion, CSP can be implemented safely and effectively in a DGH setting. LBBAP offers superior electrical stability, shorter procedure time, and less lead revisions, supporting its preferential adoption as the default pacing strategy for CSP.