Conduction System Pacing for Cardiac Resynchronization Therapy

Abstract

Cardiac resynchronization therapy (CRT) via biventricular pacing (BiVP-CRT) is considered a mainstay treatment for symptomatic heart failure patients with reduced ejection fraction and wide QRS. However, up to one-third of patients receiving BiVP-CRT are considered non-responders to the therapy. Multiple strategies have been proposed to maximize the percentage of CRT responders including two new physiological pacing modalities that have emerged in recent years: His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Both pacing techniques aim at restoring the normal electrical activation of the ventricles through the native conduction system in opposition to the cell-to-cell activation of conventional right ventricular myocardial pacing. Conduction system pacing (CSP), including both HBP and LBBAP, appears to be a promising pacing modality for delivering CRT and has proven to be safe and feasible in this particular setting. This article will review the current state of the art of CSP-based CRT, its limitations, and future directions.

Left Bundle Branch Area Pacing to Overcome Coronary Sinus Anatomy-Related Technical Problems Encountered during Implantation of Biventricular CRT—A Case Report

“…Growing interest is observed in this form of pacing, mostly due to its potential to achieve an optimal hemodynamic response. The implantation technique is more complex, and the support of an electrophysiology recoding system is necessary; however, this pacing modality does not disturb synchronous ventricular contraction in patients with a narrow QRS complex, and, in patients with intraventricular conduction abnormalities, it provides effective resynchronization, and thus practically eliminates the risk of pacemaker-induced cardiomyopathy development [ 12 , 16 ]. Cardiologists proceeding with electrotherapy who commonly use CSP are firmly convinced that this is the best possible form of cardiac pacing, offering a natural advantage over any other pacing modality, including BiV pacing.…”