The European Society of Cardiology (ESC) has released what it describes as a “groundbreaking” consensus statement on conduction system pacing (CSP), marking a “significant milestone in the evolution of pacing therapy”. The document was officially presented at the ongoing European Heart Rhythm Association (EHRA) congress (30 March–1 April 2025, Vienna, Austria) and simultaneously published in EP Europace.
For more than 50 years, right ventricular pacing has been a standard treatment for slow heart rhythms, according to the ESC. However, in some patients, this approach can lead to reduced heart function and even heart failure (HF)—and, over the past two decades, biventricular pacing has emerged as an effective therapy for select HF patients. This is in spite of the fact that it does not always yield the desired clinical response and has certain limitations.
The ESC claims that, in the search for alternative pacing strategies, CSP—stimulation of the heart’s natural electrical conduction pathways—has gained increasing attention. His bundle pacing (HBP) was first recognised for use in selected patients in the 2021 ESC guidelines on cardiac pacing and cardiac resynchronisation therapy, and, more recently, left bundle branch area pacing has become increasingly adopted due to its perceived ease of implantation and superior electrical performance.
The ESC’s latest clinical consensus statement intends to offer updated guidance to healthcare professionals on selecting patients for CSP. Developed by leading international experts in pacing therapy and in HF, the document is endorsed by major sister societies of the ESC across the globe, including the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society (HRS) in the USA, and the Latin American Heart Rhythm Society.
A press release from the ESC notes that patient perspectives have also been incorporated into the guidelines to ensure a comprehensive and patient-centred approach. Scientific evidence has been rigorously reviewed and the document presents advice in a clear, structured format, the society further states.
“While this consensus document marks a pivotal step forward in pacing therapy, we eagerly await further insights from ongoing randomised controlled trials that will refine patient selection criteria in the coming years,” said Haran Burri (University Hospital of Geneva, Geneva, Switzerland), co-chair of the ESC clinical consensus statement and president elect of the EHRA.
“Conduction system pacing is a big step forward in the pacing world,” added Michael Glikson (Hebrew University, Jerusalem, Israel), co-chair of the ESC clinical consensus statement as well as the 2021 ESC guidelines. “Since the publication of our ESC guidelines in 2021, there have been thousands of publications on CSP, and we are already seeing a significant paradigm shift in the real-world application of pacing. This is why this document is so timely. We hope to see further progress in this area of pacing in the years to come.”
