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Conduction System Pacing — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyConduction System PacingEECC

A 68-year-old man with HFrEF (LVEF 30%), complete heart block, and a narrow QRS escape rhythm requires permanent pacing. Which pacing modality has been shown to maintain ventricular synchrony and is preferred over conventional RV pacing?

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Correct answer: B — Conduction system pacing (His bundle or left bundle branch area pacing)

Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), preserves the physiological ventricular activation sequence via the native His-Purkinje system, avoiding the dyssynchrony caused by conventional RV apical pacing. This is particularly important in patients with pre-existing HFrEF, where RV pacing-induced dyssynchrony can worsen LV function. The 2021 ESC Pacing Guidelines acknowledge CSP as an emerging alternative to CRT in selected patients. LBBAP has gained traction due to higher implant success rates and more stable thresholds compared to HBP. A leadless pacemaker does not offer CSP capability.

Reference: ESC (2021): Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy