{"id":"fd70cb3f7694","type":"article","url":"https://hartvaat.nl/2023/05/19/geleidingssysteempacing-in-europa-inzichten-uit-klinische-praktijk/","title":"Geleidingssysteempacing in Europa: inzichten uit klinische praktijk","title_en":"Conduction system pacing, a European survey: insights from clinical practice.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad019","source_url":"https://doi.org/10.1093/europace/euad019","authors":["Daniel Keene","Frédéric Anselme","Haran Burri","Óscar Cano Pérez","Karol Čurila","Michael Derndorfer","Paul Foley","László Gellér","Michael Glikson","Wim Huybrechts","Marek Jastrzebski","Krzysztof Kaczmarek","Grigorios Katsouras","Jonathan Lyne","Pablo Peñafiel Verdú","Christian Restle","Sergio Richter","Stefan Timmer","Kevin Vernooy","Zachary Whinnett"],"significance":5,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This European survey documented the current landscape of conduction system pacing practice, showing growing adoption of His bundle and left bundle branch area pacing with variability in technique and indications.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Europese enquête documenteerde de huidige praktijk van geleidingssysteempacing (CSP). CSP wordt steeds vaker toegepast, maar de implementatie varieert sterk tussen centra. Standaardisatie van technieken en indicaties is nodig.","abstract_original":"AIMS: The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. METHODS AND RESULTS: A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. CONCLUSIONS: This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking."}