Abstract：
OBJECTIVE: Cardiac pacing has evolved in recent years currently culminating in the specific stimulation of the cardiac conduction system (conduction system pacing, CSP). This review aims to provide a comprehensive overview of the available literature on CSP, focusing on a critical classification of studies comparing CSP with standard treatment in the two fields of pacing for bradycardia and cardiac resynchronization therapy in patients with heart failure. The article will also elaborate specific benefits and limitations associated with CSP modalities of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP).
RESULTS: Based on a growing number of observational studies for different indications of pacing therapy, both CSP modalities investigated are advantageous over standard treatment in terms of narrowing the paced QRS complex and preserving or improving left ventricular systolic function. Less consistent evidence exists with regard to the improvement of heart failure-related rehospitalization rates or mortality, and effect sizes vary between HBP and LBBAP. LBBAP is superior over HBP in terms of lead measurements and procedural duration. With regard to all reported outcomes, evidence from large scale randomized controlled clinical trials (RCT) is still scarce. CSP has the potential to sustainably improve patient care in cardiac pacing therapy if patients are appropriately selected and limitations are considered. With this review, we offer not only a summary of existing data, but also an outlook on probable future developments in the field, as well as a detailed summary of upcoming RCTs that provide insights into how the journey of CSP continues.
RESULTS: Based on a growing number of observational studies for different indications of pacing therapy, both CSP modalities investigated are advantageous over standard treatment in terms of narrowing the paced QRS complex and preserving or improving left ventricular systolic function. Less consistent evidence exists with regard to the improvement of heart failure-related rehospitalization rates or mortality, and effect sizes vary between HBP and LBBAP. LBBAP is superior over HBP in terms of lead measurements and procedural duration. With regard to all reported outcomes, evidence from large scale randomized controlled clinical trials (RCT) is still scarce. CSP has the potential to sustainably improve patient care in cardiac pacing therapy if patients are appropriately selected and limitations are considered. With this review, we offer not only a summary of existing data, but also an outlook on probable future developments in the field, as well as a detailed summary of upcoming RCTs that provide insights into how the journey of CSP continues.
摘要：
目的：近年来，心脏起搏的发展目前达到了心脏传导系统的特定刺激（传导系统起搏，CSP)。这篇综述旨在全面概述有关CSP的现有文献，重点是在心力衰竭患者的心动过缓起搏和心脏再同步治疗两个领域中比较CSP与标准治疗的研究的关键分类。本文还将详细阐述与His束起搏（HBP）和左束支区域起搏（LBBAP）的CSP模式相关的具体益处和局限性。
结果：基于越来越多的不同起搏治疗适应症的观察性研究，所研究的两种CSP模式在缩小起搏QRS波和保留或改善左心室收缩功能方面均优于标准治疗.关于心力衰竭相关再住院率或死亡率的改善，存在不那么一致的证据。HBP和LBBAP之间的效应大小不同。LBBAP在导联测量和手术持续时间方面优于HBP。关于所有报告的结果，大规模随机对照临床试验（RCT）的证据仍然很少。如果适当选择并考虑患者的局限性，CSP有可能持续改善心脏起搏治疗中的患者护理。通过这次审查,我们不仅提供现有数据的摘要，而且还展望了该领域未来可能的发展，以及即将到来的RCT的详细摘要，这些RCT提供了有关CSP旅程如何继续的见解。
结果：基于越来越多的不同起搏治疗适应症的观察性研究，所研究的两种CSP模式在缩小起搏QRS波和保留或改善左心室收缩功能方面均优于标准治疗.关于心力衰竭相关再住院率或死亡率的改善，存在不那么一致的证据。HBP和LBBAP之间的效应大小不同。LBBAP在导联测量和手术持续时间方面优于HBP。关于所有报告的结果，大规模随机对照临床试验（RCT）的证据仍然很少。如果适当选择并考虑患者的局限性，CSP有可能持续改善心脏起搏治疗中的患者护理。通过这次审查,我们不仅提供现有数据的摘要，而且还展望了该领域未来可能的发展，以及即将到来的RCT的详细摘要，这些RCT提供了有关CSP旅程如何继续的见解。
