Conduction System Pacing: The future of pacing?


Take Home Messages
  • Conduction system pacing, (His-bundle and left bundle area pacing) is an emerging alternative method of pacing that is gaining prominence for superiority demonstrated in observational data when compared to conventional pacing.
  • The level of block in the conduction system needs to be considered before lead implant in order to ensure lead placement is distal to the level of block.
  • Technical challenges such as a higher capture threshold, less accessible anatomy and no dedicated device autoregulation algorithms remain an obstacle.
  • Conduction system pacing is most commonly considered in biventricular pacing with a failed left ventricular lead implant, and as a primary implant in patient undergoing concomitant AV node ablation, patients with heart failure and biventricular pacing indications and in AV block.

Conduction system pacing (CSP) is a novel method of cardiac pacing that uses the heart’s own conduction system to enable efficient, physiological ventricular activation (1,2).

Right ventricular pacing (RVP) and biventricular pacing (BVP) are the known conventional pacing methods. In RVP, by the nature of lead placement, inter-ventricular dysynchrony is introduced. In patients with left bundle branch block (LBBB) and severe left ventricular dysfunction, dysynchrony is particularly deleterious, and so a left ventricular lead is added in an endeavour to overcome this dysynchrony (3–5).

Conduction system pacing, through careful placement of the lead in the His-bundle or the left bundle area (LBA), provides an alternative to overcome inter-ventricular dysynchrony through physiological activation (5,6).