Conduction system pacing is an alternative practice to conventional
right ventricular apical pacing. It is a method that maintains
physiologic ventricular activation, based on a correct
pathophysiological basis, in which the pacing lead bypasses the lesion
of the electrical fibers, and the electrical impulse transmits through
the intact adjacent conduction system. For this reason, it might
reasonably characterized by the term “electrical bypass” compared to
the coronary artery bypass in revascularization therapy. In this review
reference is made to the sequence of events that conventional right
ventricular pacing may cause adverse outcomes. Furthermore, there is a
reference to alternative strategies and pacing sites. Interest focuses
on the modalities for which there is data from the literature, namely
for the Right Ventricular (RV) septal pacing, the His Bunde pacing
(HBP), and the Left Bundle Branch pacing (LBBP). A more extensive
reference is about the HBP, for which there are the most updating data.
We analyze the considerations that limit HBP wide application in three
axes, and we also present the data for the implantation and follow-up of
these patients. Then, the indications with their most important studies
to date are described in detail, not only in their undoubtedly positive
findings but also in their weak aspects, because of which, this pacing
mode has not yet received a strong recommendation for implementation.
Finally, there is a report on LBBP, focusing mainly on its points of
differentiation from HBP.