Advances in Optimizing Conduction System Pacing - Powered by AliveCor-Advances in Optimizing Conduction System Pacing

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The panel discussed whether conduction system pacing (CSP), especially left bundle branch area pacing, is ready to replace traditional RV apical pacing. Most agreed it is already preferable for bradycardia pacing because it is more physiologic and may reduce pacing-induced cardiomyopathy, even if some implants are only deep septal rather than true conduction capture.<br /><br />A major theme was that CSP, especially for CRT patients, still lacks standardized definitions and reliable criteria. The speakers stressed that current ECG-based criteria are variable, often ambiguous, and not consistently applied across trials, which may explain conflicting study results. They called for better phenotyping of conduction disease, more precise definitions of capture, and improved tools such as mapping and AI.<br /><br />The group also discussed leadless pacing, extraction of septal leads, and pacing around tricuspid/TAVR interventions. They viewed leadless CSP as promising but still early, and emphasized that follow-up must confirm continued capture, ideally with automated monitoring. For programming, many preferred unipolar pacing to help detect loss of capture early. Overall, the panel was optimistic but agreed CSP must be held to a high standard, especially when used as an alternative to proven CRT therapy.

Keywords

conduction system pacing

left bundle branch area pacing

bradycardia pacing

pacing-induced cardiomyopathy

CRT

capture criteria

leadless pacing

AI mapping