The Evolution of Physiologic Cardiac Pacing

Abstract

Conventional right ventricular pacing (RVP) methods are associated with an increased risk of atrial fibrillation, hospitalization for heart failure, pacing-induced cardiomyopathy (PICM) and associated death. Other methods such as biventricular pacing (BiVP) have indeed shown improvement in morbidity and mortality in patients with advanced heart failure with left bundle branch block, but the method used remains non-physiological in that the activation spreads between the right ventricular (RV) endocardium and left ventricular (LV) epicardium. Physiologic pacing stimulates the heart's natural conduction pathways, resulting in synchronous ventricular contractions. This can prevent complications such as in the RVP method. The possibility of stimulating His bundle and left bundle branch in patients with bradycardia and conduction system disorders in order to obtain the most physiological method and approach the intrinsic pathway makes the development of conduction system pacing more interesting. In this review, we summarize the evolution of physiologic cardiac pacing and the challenges it faces in order to achieve better outcomes for patients.