His-Purkinje Conduction System Pacing
Abstract
Introduction
His bundle pacing
Implantation technique and success rates
His bundle pacing as an alternative to right ventricular pacing
His bundle pacing as an alternative to biventricular pacing
Left bundle branch (area) pacing
Implantation technique and success rates
Left bundle branch (area) pacing as an alternative to right ventricular pacing
Left bundle branch (area) pacing as an alternative to biventricular pacing
Key points
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- HBP and LBBAP are increasingly being adopted as alternatives to current standard right ventricular and biventricular pacing techniques.
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- HBP provides the most physiological ventricular activation, but there is concern about high capture thresholds and a high rate of lead revisions, which may be mitigated by a more liberal use of ventricular backup leads.
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- LBBAP is a recently introduced pacing modality, which seems to provide excellent electrical parameters (without the requirement for backup ventricular pacing), but the long-term performance and lead extractability remains to be evaluated. It is currently a valuable alternative if HBP does not yield satisfactory results.
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- Although there is a growing volume of observational data on these pacing modalities, there is a dire need for randomised studies to prove their safety and efficacy for them to be fully implemented in practice guidelines.
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- Patients expected to be paced >20% of the time (nodal and infra-nodal atrioventricular block; slowly conducted atrial fibrillation, pacing-induced cardiomyopathy)
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- As part of an ablate and pace strategy in rapidly conducted atrial fibrillation
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- Failed coronary sinus lead implantation for patients with a CRT indication
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- Non-responders to biventricular pacing
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- In combination with left ventricular or biventricular pacing for His-optimised CRT (in patients with permanent atrial fibrillation in whom the HBP or LBBAP lead may be connected to the atrial port)
Funding
References
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Elise, B.; Haran, B. His-Purkinje Conduction System Pacing. Cardiovasc. Med. 2021, 24, 61. https://doi.org/10.4414/cvm.2021.02159
Elise B, Haran B. His-Purkinje Conduction System Pacing. Cardiovascular Medicine. 2021; 24(3):61. https://doi.org/10.4414/cvm.2021.02159
Chicago/Turabian StyleElise, Bakelants, and Burri Haran. 2021. "His-Purkinje Conduction System Pacing" Cardiovascular Medicine 24, no. 3: 61. https://doi.org/10.4414/cvm.2021.02159
APA StyleElise, B., & Haran, B. (2021). His-Purkinje Conduction System Pacing. Cardiovascular Medicine, 24(3), 61. https://doi.org/10.4414/cvm.2021.02159