Studies have shown that left bundle branch area pacing (LBBaP) is not inferior to biventricular-cardiac resynchronization therapy (BIV-CRT) in the treatment of heart failure with cardiac electromechanical activity asynchrony. The patient in this report was a 72-year-old heart failure patient needing cardiac resynchronization therapy (CRT). The LBBaP approach was attempted firstly, but it failed to achieve cardiac electromechanical activity synchronization. Then, the BIV-CRT strategy was selected and performed successfully. The patient’s heart function has greatly improved at the postoperative follow-up. Therefore, BIV-CRT remains an irreplaceable treatment for certain patients.

BackgroundCardiac resynchronization therapy (CRT) is an established treatment option for heart failure patients. However, the implementation of triple‐chamber pacemakers can be cost‐prohibitive. His‐Purkinje system pacing (HPSP) can also enable cardiac resynchronization, and it can be achieved with relatively inexpensive conventional pacemakers.HypothesisThis article aims to comparatively evaluate the cost of implanting devices in different CRT strategies to provide meaningful guidance for clinical decision‐making by electrophysiologists.MethodsData was collected on the prices, designed life, and price/designed life of multiple mainstream models of CRT‐P, CRT‐D, dual‐chamber pacemakers, and single‐chamber pacemakers that were sold in the Chinese market in 2022. The prices, designed lives, and price/designed life of different pacemaker models were then compared.ResultsThe costs of CRT‐P and CRT‐D (13008.44 ± 2752.30 USD and 22043.36 ± 3676.25 USD) were significantly higher than those of conventional pacemakers (dual‐chamber: 11142.39 ± 4273.85 USD and single‐chamber: 5634.28 ± 2032.80 USD) (p < .05). Additionally, the price/designed life of conventional pacemakers (dual‐chamber: 839.63 ± 258.62 US dollar/year and single‐chamber: 435.86 ± 125.44 US dollar/year) was significantly better than that of CRT‐P and CRT‐D (1386.91 ± 266.73 and 2585.53 ± 520.27 US dollar/year, respectively) (p < .05).ConclusionConduction system pacing (CSP)‐based CRT is more cost‐effective than BVP‐based CRT. Furthermore, CSP‐based CRT can achieve cardiac resynchronization with conventional pacemakers and may be a good option for HF patients who do not need defibrillation.