• Biventricular pacing (BiVP) remains the standard of care for heart failure with reduced ejection fraction and left bundle branch block, but conduction system pacing (CSP) is an alternative if BiVP is not feasible.
• CSP is non-inferior to BiVP in reducing QRS duration and improving left ventricular ejection fraction.
• It is uncertain whether there is a difference in mortality and morbidity between the two groups.
Biventricular pacing (BiVP) is an established treatment for reducing morbidity and mortality in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). (1) It works by reducing ventricular dyssynchrony. However, approximately one third of patients are non-responders to BiVP, particularly those with non-LBBB morphology or QRS complex duration <150ms. Procedural factors also impact the success rate of BiVP (Figure 1). Thus, alternative pacing modalities are being explored. Conduction system pacing (CSP) is being increasingly utilised as an option for those with a bradycardia pacing indication to prevent ventricular dyssynchrony and the resulting decline in cardiac function. It is also being investigated as a first-line alternative to BiVP in HFrEF and LBBB.
Author Sub-editor: Dr Pok-Tin Tang Dr Pok-Tin Tang is an ST5 cardiology registrar in the Thames Valley deanery, currently undertaking a period of out of
Author Sub-editor: Dr May Hu Dr May Hu is a cardiology trainee in the North West deanery. She graduated with First Class Honours from the University
Author Sub-editor: Dr Jhiamluka Solano Dr Jhiamluka Solano is a cardiology resident doctor (ST6) in the Yorkshire and Humber Deanery, currently undertaking a DPhil (PhD)
Author Sub-editor: Dr Joshua Rowland Dr Joshua Rowland is a cardiology registrar working in the North West Deanery. He graduated from the University of Manchester
Author Sub-editor: Dr Atmadeep Banerjee Dr Atmadeep Banerjee is an ST4 Cardiology Registrar in the Kent, Surrey and Sussex deanery. He graduated from Calcutta National
