Highlights
- •His-Purkinje conduction system pacing is expected to induce physiological left ventricular activation.
- •Conduction system pacing has demonstrated favor outcome, compared with right ventricular pacing in observational studies.
- •Conduction system pacing may provide better cardiac resynchronization therapy than traditional biventricular pacing.
Summary
Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle
branch area pacing (LBBAP), is the most physiological of all pacing modalities for
ventricular capture and a potential alternative to right ventricular pacing. It induces
electrical and mechanical dyssynchrony, resulting in left ventricular dysfunction,
heart failure hospitalization, and atrial arrhythmia. CSP activates the normal conduction
system and restores ventricular synchrony. In 2000, HBP was first performed as permanent
ventricular pacing, which improved left ventricular systolic dysfunction. The feasibility
of permanent HBP has already been demonstrated in patients with bradycardia, although
a high capture threshold and limited efficacy for infra-Hisian conduction diseases
remain critical issues. The LBBAP is an alternative pacing form that overcomes the
limitations of the HBP. A lower capture threshold was obtained at implantation and
preserved during the follow-up period in patients with LBBAP. Cardiac resynchronization
therapy with HBP or LBBAP may provide better synchronization than the traditional
biventricular pacing. Hybrid therapy utilizing HBP or LBBAP in combination with left
ventricular pacing has been introduced to treat patients with heart failure. In this
review, we have focused on the clinical implications, limitations, and a literature
review on CSP.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 28, 2023
Accepted:
January 17,
2023
Received:
January 5,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
