Conduction System Pacing – Technik, Evidenz und klinische Perspektiven

Zusammenfassung

Conduction System Pacing ermöglicht eine direkte Erregung des physiologischen Erregungsleitungssystems und bietet eine hämodynamisch überlegene Alternative zur konventionellen ventrikulären Stimulation. Die His-Bündel-Stimulation erlaubt eine synchrone physiologische Aktivierung beider Ventrikel, ist jedoch technisch anspruchsvoll und mit höheren Reizschwellen verbunden. Das Left Bundle Branch Area Pacing weist eine höhere Erfolgsrate, stabilere elektrische Parameter und einfachere Implantationsbedingungen auf. Conduction System Pacing zeigt Vorteile bei AV-Block, Bradykardie, Herzinsuffizienz, nach AV-Knoten-Ablation und in der kardialen Resynchronisationstherapie bei Non-Response oder technischen Limitationen. Künftige Entwicklungen betreffen spezifische Elektroden, kabellose Systeme sowie Strategien zur sicheren Explantation und Anwendung bei speziellen Patientengruppen.

Abstract

Conduction system pacing activates the physiological conduction system directly and provides a hemodynamically favorable alternative to conventional ventricular pacing. His bundle pacing enables synchronous biventricular activation but is technically challenging and associated with higher pacing thresholds. Left bundle branch area pacing offers higher implantation success, more stable electrical parameters, and simpler procedural characteristics. Conduction system pacing demonstrates advantages in AV block, bradycardia, heart failure, post-AV node ablation, and in cardiac resynchronization therapy in case of non-response or technical failure. Future developments include specific leads, wireless systems, and safe extraction strategies, especially in pediatric or structurally complex patients.

Schlüsselwörter

His-Bündel-Stimulation - kardinale Resynchronisationstherapie - Conduction System Pacing - Linksschenkelbereichsstimulation

Keywords

conduction system pacing - His bundle pacing - left bundle branch area pacing - cardiac resynchronization therapy

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