Open AccessHis–Purkinje Conduction System Pacing: State of the Art in 2020
Author(s) -
Ahran Arnold,
Zachary I. Whinnett,
Pugazhendhi Vijayaraman
Publication year - 2020
Publication title -
arrhythmia and electrophysiology review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.008
H-Index - 18
eISSN - 2050-3377
pISSN - 2050-3369
DOI - 10.15420/aer.2020.14
Subject(s) - electrical conduction system of the heart , bundle , qrs complex , left bundle branch block , medicine , cardiology , stylet , intraventricular conduction , bundle branch block , neuroscience , electrocardiography , anatomy , heart failure , psychology , materials science , composite material
Conduction system pacing involves directly stimulating the specialised His-Purkinje cardiac conduction system with the aim of activating the ventricles physiologically, in contrast to the dyssynchronous activation produced by conventional myocardial pacing. Since the first report of permanent His bundle pacing (HBP) in 2000, the stylet-driven technique of its earliest incarnation has been superseded by a more successful stylet-less approach. Widespread uptake has led to a much greater evidence base. Single-centre observational studies have now been supported by large multicentre, international registries, mechanistic studies and the first randomised controlled trials. New evidence has elucidated mechanisms of HBP and illustrated the nature and magnitude of its potential benefits for preventing pacing-induced cardiomyopathy and correcting bundle branch block. Left bundle branch pacing (LBBP) is a newer technique in which the lead is fixed deep into the left side of the intraventricular septum to allow capture of the left bundle, distal to the His bundle. LBBP holds promise as a method for physiological pacing that overcomes some of the fixation, threshold and sensing challenges of HBP. In this state-of-the-art review of His-Purkinje conduction system pacing, the authors assess recent evidence and current practice and explore emerging and future directions in this rapidly evolving field.