Causes of Failures and Complications in Stimulation of the Conduction System Pacing

Conductive system stimulation relies on the direct stimulation of His-Purkinje’s specialized cardiac conduction system for physiological activation of the ventricles, as opposed to asynchronous activation induced by conventional myocardial stimulation. Since the first report of permanent His bundle stimulation in 2000, the stylet-based technique has undergone significant advances in technology. Single-center observational studies have now been supported by large multicenter, international registries, meta-analysis 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.