Challenges and Pitfalls of His-Purkinje Conduction System Pacing

Chronic right ventricular pacing has deleterious effects on cardiac function and functional status due to abnormal activation. Although right ventricular pacing is safe and effective at restoring heart rate and reducing bradycardia-induced symptoms for most patients, pacing-induced heart failure and cardiomyopathy are induced in some patients. His-Purkinje conduction system pacing including direct His bundle pacing and left bundle branch pacing may improve dyssynchrony induced by cardiac pacing and cardiac function. Specially designed pacing lead and delivery tools improve success rate of direct pacing of His-Purkinje conduction system. Direct His-Purkinje conduction system pacing is expected as an alternative method of cardiac resynchronization therapy. However, there are many problems to be solved in this method including technical difficulties of lead fixation in His-Purkinje conduction system, high pacing threshold, long-term stability and safety. Long-term results of His-Purkinje conduction system still remain unknown. In this symposium, we want to discuss about challenges and pitfalls of His-Purkinje conduction system pacing.