The Beat Episode 21 Evolution of Conduction System Pacing in India (Hindi language episode) On-Demand-The Beat Episode 21

Video Transcription

Video Summary

The Heart Rhythm Society (HRS) and Indian Heart Rhythm Society (IHRS) collaboratively hosted a historic BEAT webinar on January 21, 2026, marking the first global expansion of the BEAT series into India and local languages. The session focused on the evolution of conduction system pacing (CSP), particularly left bundle branch area pacing, as a physiological alternative to traditional right ventricular (RV) pacing for bradycardia and heart failure management.<br /><br />Panel experts discussed randomized controlled trials (PACE-HF, CS-PACE, PRAG-CS) showing that CSP is feasible, safe, and potentially superior in patients with compromised ejection fraction, though uptake is limited by higher lead revision rates and the need for improved hardware. CSP promotes natural ventricular activation, reducing pacing-induced cardiomyopathy risks seen with RV pacing.<br /><br />The role of CSP versus biventricular cardiac resynchronization therapy (CRT) was debated. While CSP can suffice, especially in non-ischemic cardiomyopathy with typical left bundle branch block, CRT remains essential in ischemic or scarred myocardium. The approach is patient-tailored using QRS morphology, scar assessment, and intra-procedural electrical measurements like R-wave peak time.<br /><br />Technical considerations included lead types (lumenless vs stylet-driven), implantation challenges, lead stability, and the importance of deep, precise lead deployment for durable conduction system capture. The panel emphasized procedural learning curves, need for operator expertise, and nationwide registries to track outcomes.<br /><br />Emerging areas like Backman bundle atrial pacing for atrial block and heart failure were highlighted, and future innovations desired include better lead designs, dedicated devices with CSP algorithms, and imaging tools to visualize conduction fibers during implantation.<br /><br />The webinar underscored CSP’s promise but stressed continued research, training, and infrastructure development for widespread adoption in India and globally.

Keywords

Heart Rhythm Society

Indian Heart Rhythm Society

conduction system pacing

left bundle branch area pacing

right ventricular pacing

bradycardia management

heart failure

randomized controlled trials

cardiac resynchronization therapy

lead implantation techniques

cardiac pacing innovations