The Beat Episode 22: The Beat in Many Languages: Update on Cardiac Pacing Therapy (Spanish Language Episode) On Demand-The Beat Episode 22

Video Transcription

Video Summary

The webinar "Update on Cardiac Pacing Therapy," presented in Spanish by experts from Latin America, Spain, Canada, and beyond, provided a comprehensive overview of cardiac pacing's history, current advances, and future directions. Dr. Félix Ayala Paredes traced the evolution from early external and first implanted pacemakers in the mid-20th century to modern developments, including biological pacemakers using gene therapy and bioresorbable devices.<br /><br />Dr. José Carlos Pachón emphasized the physiological basis of pacing, highlighting the synchronization of the heart's conduction system—specifically the His-Purkinje system—and the detrimental effects of non-physiological pacing causing ventricular dyssynchrony and cardiomyopathy. He reviewed advances in conduction system pacing (CSP), focusing on left bundle branch area pacing as superior to traditional biventricular pacing with a more natural, endocardium-to-epicardium activation sequence.<br /><br />Dr. Diego Egas discussed leadless pacemakers, a disruptive technology offering pacing without transvenous leads, significantly reducing complications such as infections and lead fractures. He highlighted the progression from early bulky devices to modern miniaturized ones with improved longevity and physiological pacing capabilities, projecting widespread adoption by 2028.<br /><br />Dr. Margarida Puyol López addressed patient selection and personalization of pacing therapy. She stressed that no single modality suits all patients and noted the limitations and failure rates of both biventricular and conduction system pacing. She described ongoing research (LEAR CRT study) aiming to tailor resynchronization therapy based on individual conduction system pathology and cardiac substrate.<br /><br />Throughout the discussion, the experts agreed that physiological pacing reduces pacing-induced cardiomyopathy but acknowledged challenges in identifying patients who will benefit most. Emerging imaging and electrophysiological tools promise better patient stratification. The experts emphasized that combining conduction system pacing and leadless technology represents the future for safer, more effective, and personalized cardiac pacing therapies.

Keywords

Cardiac Pacing Therapy

Physiological Pacing

Conduction System Pacing

Leadless Pacemakers

Biological Pacemakers

Left Bundle Branch Area Pacing

Biventricular Pacing

Pacing-Induced Cardiomyopathy

Heart Conduction System

Personalized Pacing Therapy

LEAR CRT Study