Real-World Performance of Conduction System Pacing Compared With Traditional Pacing

Conventional biventricular pacing is still preferred to conduction system pacing for atrioventricular block in patients with reduced ejection fraction and narrow QRS

“…In the Carelink™-based analysis 1.8% of patients had threshold rise to an absolute value > 2.0 V over 18 months of observation. 41 This compares well to the capture thresholds during BiVP, and much more favourably to it when the total energy consumption is compared, because BiVP requires pacing from two ventricular sites while LBBAP is a single site pacing technique.…”

“…The average capture threshold during LBBAP is very similar to that seen with conventional RV pacing, for example—it was 0.6 V in MELOS 47 and 0.5 V in the large dataset obtained from the Carelink™ (Medtronic, MN, USA) database. 41 In MELOS, 47 during follow-up of 6.4 ± 5.7 months the capture threshold remained stable with only 0.7%, 0.6%, and 0.16% of patients experiencing threshold rise over 1 V from baseline or to an absolute threshold value > 2.0 V or requiring lead repositioning due to threshold rise, respectively. In the Carelink™-based analysis 1.8% of patients had threshold rise to an absolute value > 2.0 V over 18 months of observation.…”

“…The situation is nevertheless evolving, as CSP has been implanted in tens of thousands of patients worldwide. 41 …”

“…Sensing in the LBBAP position when programmed to bipolar is also comparable to RV pacing as the ring electrode ensures ample myocardium and is almost never an issue (average sensing of 10.6 mV in MELOS and 13 mV in the Carelink™ database). 41 , 47 …”