Conduction System Pacing on Track to Replace CRT? Review of Current Evidence and Prospects of Conduction System Pacing

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Aug 31

PMID 37649666

Authors

Ahmed T Moustafa

Anthony Sl Tang

Habib Rehman Khan

Affiliations

Soon will be listed here.

Abstract

Conduction system pacing (CSP) has been emerging over the last decade as a pacing option instead of conventional right ventricular (RV) pacing and biventricular (BiV) pacing. Numerous case reports, some observational studies and a few randomized control trials have looked at optimum pacing strategies for heart failure (HF) with left bundle branch block (LBBB) or cases where left ventricular (LV) dysfunction is anticipated due to chronic RV pacing (RVP). Evolution of pacing strategies from standard RVP to septal RVP, BiV pacing and now CSP have shown improving hemodynamic responses and possible ease of implantation of CSP systems. In this review article, we review the literature on the evolution of CSP and common scenarios where it might be beneficial.

Citing Articles

His Bundle Pacing and Left Bundle Branch Pacing in Patients with Heart Failure.

Paluszkiewicz P, Martuszewski A, Radziejewska J, Zawadzki J, Smereka J, Gajek J Biomedicines. 2024; 12(10).

PMID: 39457668 PMC: 11504024. DOI: 10.3390/biomedicines12102356.

References

Zizek D, Antolic B, Meznar A, Zavrl-Dzananovic D, Jan M, Stublar J . Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS. Acta Cardiol. 2021; 77(3):222-230. DOI: 10.1080/00015385.2021.1903196. View

Gamble J, Bashir Y, Rajappan K, Betts T . Left ventricular endocardial pacing via the interventricular septum for cardiac resynchronization therapy: first report. Heart Rhythm. 2013; 10(12):1812-4. DOI: 10.1016/j.hrthm.2013.07.033. View

Ponnusamy S, Vijayaraman P . Aborted ST-elevation myocardial infarction-An unusual complication of left bundle branch pacing. HeartRhythm Case Rep. 2020; 6(8):520-522. PMC: 7424302. DOI: 10.1016/j.hrcr.2020.05.010. View

Vijayaraman P, Subzposh F, Naperkowski A, Panikkath R, John K, Mascarenhas V . Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm. 2019; 16(12):1774-1782. DOI: 10.1016/j.hrthm.2019.05.011. View

Goldenberg I, Kutyifa V, Klein H, Cannom D, Brown M, Dan A . Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med. 2014; 370(18):1694-701. DOI: 10.1056/NEJMoa1401426. View

Arnold A, Shun-Shin M, Keene D, Howard J, Sohaib S, Wright I . His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block. J Am Coll Cardiol. 2018; 72(24):3112-3122. PMC: 6290113. DOI: 10.1016/j.jacc.2018.09.073. View

Brignole M, Pentimalli F, Palmisano P, Landolina M, Quartieri F, Occhetta E . AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021; 42(46):4731-4739. DOI: 10.1093/eurheartj/ehab569. View

Jastrzebski M, Kielbasa G, Cano O, Curila K, Heckman L, De Pooter J . Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J. 2022; 43(40):4161-4173. PMC: 9584750. DOI: 10.1093/eurheartj/ehac445. View

Sanchez-Quintana D, Ho S . [Anatomy of cardiac nodes and atrioventricular specialized conduction system]. Rev Esp Cardiol. 2003; 56(11):1085-92. DOI: 10.1016/s0300-8932(03)77019-5. View

10.

Healey J, Hohnloser S, Exner D, Birnie D, Parkash R, Connolly S . Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT). Circ Heart Fail. 2012; 5(5):566-70. DOI: 10.1161/CIRCHEARTFAILURE.112.968867. View

11.

Jastrzebski M, Moskal P, Huybrechts W, Curila K, Sreekumar P, Rademakers L . Left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT): Results from an international LBBAP collaborative study group. Heart Rhythm. 2021; 19(1):13-21. DOI: 10.1016/j.hrthm.2021.07.057. View

12.

Jastrzebski M . ECG and Pacing Criteria for Differentiating Conduction System Pacing from Myocardial Pacing. Arrhythm Electrophysiol Rev. 2021; 10(3):172-180. PMC: 8576513. DOI: 10.15420/aer.2021.26. View

13.

Odland H, Holm T, Gammelsrud L, Cornelussen R, Kongsgaard E . Determinants of LV dP/dt and QRS duration with different fusion strategies in cardiac resynchronisation therapy. Open Heart. 2021; 8(1). PMC: 8108692. DOI: 10.1136/openhrt-2021-001615. View

14.

Zu L, Wang Z, Hang F, Jiang Y, Wang X, Cheng L . Cardiac resynchronization performed by LBBaP-CRT in patients with cardiac insufficiency and left bundle branch block. Ann Noninvasive Electrocardiol. 2021; 26(6):e12898. PMC: 8588377. DOI: 10.1111/anec.12898. View

15.

Baller D, Wolpers H, Zipfel J, BRETSCHNEIDER H, Hellige G . Comparison of the effects of right atrial, right ventricular apex and atrioventricular sequential pacing on myocardial oxygen consumption and cardiac efficiency: a laboratory investigation. Pacing Clin Electrophysiol. 1988; 11(4):394-403. DOI: 10.1111/j.1540-8159.1988.tb05998.x. View

16.

Kusumoto F, Schoenfeld M, Barrett C, Edgerton J, Ellenbogen K, Gold M . 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart.... Circulation. 2018; 140(8):e382-e482. DOI: 10.1161/CIR.0000000000000628. View

17.

Vijayaraman P, Sharma P, Cano O, Ponnusamy S, Herweg B, Zanon F . Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy. J Am Coll Cardiol. 2023; 82(3):228-241. DOI: 10.1016/j.jacc.2023.05.006. View

18.

Sharma P, Patel N, Ravi V, Zalavadia D, Dommaraju S, Garg V . Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry. Heart Rhythm. 2021; 19(1):3-11. DOI: 10.1016/j.hrthm.2021.08.033. View

19.

Aiba T, Hesketh G, Barth A, Liu T, Daya S, Chakir K . Electrophysiological consequences of dyssynchronous heart failure and its restoration by resynchronization therapy. Circulation. 2009; 119(9):1220-30. PMC: 2703676. DOI: 10.1161/CIRCULATIONAHA.108.794834. View

20.

Kronborg M, Mortensen P, Poulsen S, Gerdes J, Jensen H, Nielsen J . His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace. 2014; 16(8):1189-96. DOI: 10.1093/europace/euu011. View