Conduction system optimized cardiac resynchronization therapy- exceptional modality of cardiac pacing in patients with severe heart failure. A hope for non-responders?

For many years, the apex of the right ventricle (RV) seemed to be a sufficiently good site for ventricular pacing, effectively protecting both the health and life of patients with atrioventricular conduction disorders. However, the studies have demonstrated that this is not an optimal site, since it leads to electrical and mechanical interventricular asynchrony, which in some cases (15-20 ​%) results in the development of pacing-induced cardiomyopathy (PICM). The introduction of biventricular cardiac resynchronization therapy (BiV-CRT) into clinical practice was a real breakthrough in the development of modern electrotherapy, and conduction system pacing (CSP) has heralded even greater hopes. The CSP-optimized CRT is the most complex modality of CRT, involving the simultaneous pacing of His bundle or its left branch, and additionally, epicardial pacing of the left ventricle. This modality of pacing may represent the most optimal method for spreading the ventricle depolarization wave in severely damaged cardiac muscle and may represent a real hope for patients who do not adequately respond to other forms of CRT.