New ESC consensus statement advances conduction system pacing therapy

The European Society of Cardiology (ESC) has released a groundbreaking consensus statement on conduction system pacing (CSP), marking a significant milestone in the evolution of pacing therapy. The document was officially presented today at the EHRA 2025 congress in Vienna and simultaneously published in EP Europace. 

For over 50 years, right ventricular pacing has been a standard treatment for slow heart rhythms. However, in some patients, this approach can lead to reduced heart function and even heart failure. Furthermore, biventricular pacing has emerged over the past two decades as an effective therapy for select heart failure patients. Yet it does not always yield the desired clinical response and has certain limitations. 

In the search for alternative pacing strategies, conduction system pacing-stimulation of the heart's natural electrical conduction pathways-has gained increasing attention. His bundle pacing (HBP) was first recognised for use in selected patients in the 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. More recently, left bundle branch area pacing is being increasingly adopted due to its perceived ease of implantation and superior electrical performance. 

ESC Clinical Consensus Statement offers updated guidance to healthcare professionals on selecting patients for conduction system pacing. Developed by leading international experts in pacing therapy and in heart failure, the document is endorsed by major Sister Societies worldwide, including the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society (United States), and the Latin American Heart Rhythm Society. Notably, the patient perspective has also been incorporated to ensure a comprehensive and patient-centered approach. Scientific evidence has been rigorously reviewed, and the document presents advice in a clear, structured format. 

While this consensus document marks a pivotal step forward in pacing therapy, we eagerly await further insights from ongoing randomized controlled trials that will refine patient selection criteria in the coming years." 

Professor Haran Burri, Co-chair of the ESC Clinical Consensus Statement and EHRA President-Elect

Professor Michael Glikson, Co-chair of the ESC Clinical Consensus Statement and the 2021 ESC Guidelines: "Conduction system pacing is a big step forward in the pacing world. Since the publication of our ESC guidelines in 2021, there have been thousands of publications on CSP, and we are already seeing a significant paradigm shift in the real-world application of pacing. This is why this document is so timely. We hope to see further progress in this area of pacing in the years to come."