Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time. This Clinical Consensus Statement provides advice on indications for CSP, taking into account the significant evolution in this domain.

• Klíčová slova
• Biventricular pacing, Cardiac resynchronization therapy, Conduction system pacing, His bundle pacing, Indications, Left bundle branch area pacing,
• MeSH
• akční potenciály MeSH
• kardiologie * normy   MeSH
• kardiostimulace umělá * normy   škodlivé účinky   metody   MeSH
• konsensus MeSH
• lidé MeSH
• převodní systém srdeční * patofyziologie   MeSH
• společnosti lékařské MeSH
• srdeční arytmie * terapie   patofyziologie   diagnóza   MeSH
• srdeční frekvence MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique.

• Klíčová slova
• Conduction system pacing, Device implantation, His bundle pacing, Left bundle branch area pacing,
• MeSH
• Hisův svazek MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční * MeSH
• srdeční resynchronizační terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Kanada MeSH
• Latinská Amerika MeSH

Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique. A synopsis is provided in this print edition of EP-Europace. The full document may be consulted online, and a 'Key Messages' App can be downloaded from the EHRA website.

• Klíčová slova
• Conduction system pacing, Device implantation, His bundle pacing, Left bundle branch area pacing,
• MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Asie MeSH
• Kanada MeSH

AIMS: We hypothesized that during left bundle branch (LBB) area pacing, the various possible combinations of direct capture/non-capture of the septal myocardium and the LBB result in distinct patterns of right and left ventricular activation. This could translate into different combinations of R-wave peak time (RWPT) in V1 and V6. Consequently, the V6-V1 interpeak interval could differentiate the three types of LBB area capture: non-selective (ns-)LBB, selective (s-)LBB, and left ventricular septal (LVS). METHODS AND RESULTS: Patients with unquestionable evidence of LBB capture were included. The V6-V1 interpeak interval, V6RWPT, and V1RWPT were compared between different types of LBB area capture. A total of 468 patients from two centres were screened, with 124 patients (239 electrocardiograms) included in the analysis. Loss of LVS capture resulted in an increase in V1RWPT by ≥15 ms but did not impact V6RWPT. Loss of LBB capture resulted in an increase in V6RWPT by ≥15 ms but only minimally influenced V1RWPT. Consequently, the V6-V1 interval was longest during s-LBB capture (62.3 ± 21.4 ms), intermediate during ns-LBB capture (41.3 ± 14.0 ms), and shortest during LVS capture (26.5 ± 8.6 ms). The optimal value of the V6-V1 interval value for the differentiation between ns-LBB and LVS capture was 33 ms (area under the receiver operating characteristic curve of 84.7%). A specificity of 100% for the diagnosis of LBB capture was obtained with a cut-off value of >44 ms. CONCLUSION: The V6-V1 interpeak interval is a promising novel criterion for the diagnosis of LBB area capture.

• Klíčová slova
• Conduction system pacing, Electrocardiogram, Left bundle branch capture, Left bundle branch pacing, Left ventricular septal capture,
• MeSH
• elektrokardiografie metody   MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá metody   MeSH
• lidé MeSH
• mezikomorová přepážka * MeSH
• převodní systém srdeční MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH