SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Pacemaker therapy with conduction system pacing – past, present and future directions

█ Review

DOI: 10.26430/CHUNGARICA.2023.53.3.225

Nagy László, Tóth Anna Zsófia, Kiss Alexandra, Szabó Krisztina Mária, Nagy László Tibor, Csanádi Zoltán, Sándorfi Gábor
DE-KK, Kardiológiai és Szívsebészeti Intézet, Debrecen
Levelezési cím:
Dr. Nagy László, e-mail:

Conventional pacemaker therapy may result in the deterioration of the left ventricular function referred to as pacemaker induced cardiomyopathy, due to the electromechanical dyssynchrony induced by permanent right ventricular pacing. Cardiac resynchronisation therapy by biventricular pacemaker implantation failed to improve the prognosis in 30-50% of the HF patients. Conduction system pacing (CSP), resulting in more physiological activation of the ventricles might serve an alternative therapeutic approach in the above indications. CSP can be achieved by the direct stimulation of the His-bundle (HBP) or the left bundle branch area (LBBAP). LBBAP consists of stimulation of the left bundle branch (LBBP) or the endocardial part of the left ventricular septum (LVSP). Due to the promising results of these methods, CSP appeared in the current guidelines of the European Society of Cardiology (ESC) in limited indications. However, further randomized trials are needed for the expansion of the current ESC recommendations related to the CSP.


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