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Biventricular pacing (BVP) is the most commonly used method for delivering CRT; it has been shown in large randomized controlled trials to significantly improve morbidity and mortality in patients with heart failure. However, BVP delivers only modest reductions in ventricular activation time and is only beneficial in patients with prolonged QRS duration. In this review, we explore conduction system pacing as a method for delivering more effective ventricular resynchronization and to extend pacing therapy for heart failure to patients without left bundle branch block (LBBB).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Recent Findings<\/jats:title>\n<jats:p>The aim of conduction system pacing is to provide physiological ventricular activation by directly stimulating the conduction system. Current modalities include His bundle and left conduction system pacing. His bundle pacing is the most established method; it has the potential to correct left bundle branch block and deliver more effective ventricular resynchronization than BVP. This translates into greater acute haemodynamic improvements and observational data suggests that His-CRT results in improvements in cardiac function and symptoms. AV-optimized His bundle pacing is being investigated in patients with heart failure and long PR interval without LBBB, to see if this improves exercise capacity. More recently, a technique for pacing the left bundle branch has been developed. Early studies show potential advantages including low and stable capture thresholds.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Summary<\/jats:title>\n<jats:p>Conduction system pacing can deliver more effective ventricular resynchronization than BVP, which has the potential to deliver greater improvements in cardiac function. It may also provide the opportunity to extend pacing therapy for heart failure to patients who do not have LBBB. Further data is required from randomized trials to assess these promising pacing techniques.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s11897-020-00474-y","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T04:39:36Z","timestamp":1598589576000},"page":"288-298","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Emerging Role of Cardiac Conduction System Pacing as a Treatment for Heart Failure"],"prefix":"10.1007","volume":"17","author":[{"given":"Nadine","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew Shun","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Whinnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,28]]},"reference":[{"key":"474_CR1","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMoa050496","volume":"352","author":"JGF Cleland","year":"2005","unstructured":"Cleland JGF, Daubert J-C, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. 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This study is important as it is the first to invasively assess the location\/level of block in patients with left bundle branch block and demonstrated that only patients with left bundle branch block caused by proximal block benefit from His bundle pacing.","journal-title":"Circulation"},{"key":"474_CR25","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/europace\/eus228","volume":"15","author":"R Barba-Pichardo","year":"2013","unstructured":"Barba-Pichardo R, Manovel S\u00e1nchez A, Fern\u00e1ndez-G\u00f3mez JM, Mori\u00f1a-V\u00e1zquez P, Venegas-Gamero J, Herrera-Carranza M. Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator. Europace. 2013;15:83\u20138.","journal-title":"Europace."},{"key":"474_CR26","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/j.hrthm.2017.04.003","volume":"14","author":"OA Ajijola","year":"2017","unstructured":"Ajijola OA, Upadhyay GA, Macias C, Shivkumar K, Tung R. 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