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Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches.

Recent Findings

His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks.

Summary

There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Department of Internal Medicine, University of Chicago Medicine, Chicago, USA

    Seth D. Scheetz

  2. Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, USA

    Gaurav A. Upadhyay

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GAU reports consulting or speaking fees from Abbott, Biosense Webster, BioTel, Biotronik, Medtronic, and Zoll Medical. SDS has no disclosures.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Scheetz, S.D., Upadhyay, G.A. Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature. Curr Cardiol Rep 24, 959–978 (2022). https://doi.org/10.1007/s11886-022-01723-3

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