The New Age of Pacemakers

Discover how Conduction System Pacing (His-Bundle & Left Bundle Branch Pacing) compares to Biventricular CRT in heart failure care. Learn benefits, latest research, and how Doctors365 online cardiologists can guide your treatment decisions.

Imagine a tiny device acting as your heart’s personal electrician – that’s essentially what a pacemaker does. In recent years, two advanced pacing strategies have emerged to help patients with serious heart rhythm problems: Conduction System Pacing (CSP) and Biventricular Pacing (traditional Cardiac Resynchronization Therapy, CRT). In this article, you’ll learn the differences between CSP and biventricular CRT, why they matter for heart failure patients, and how new technology is transforming care. We’ll also explore how you can discuss these cutting-edge treatments with a cardiologist online through Doctors365. By the end, you’ll understand the pros and cons of each pacing method, what current research shows, and how telemedicine can help you make informed decisions about your heart health.

Emergency Note: Keep in mind that while online consultations are great for advice and follow-ups, if you have severe symptoms like crushing chest pain, trouble breathing, or fainting, that’s an emergency – call your local emergency number or seek in-person care immediately. Telemedicine is wonderful for guidance and routine care, but true emergencies require hands-on treatment.

(What can an online doctor do?) An online cardiologist can explain these pacing options, review your history, and guide you on next steps – but they cannot implant a device remotely. They can, however, help you decide if you might benefit from one of these pacemaker therapies and ensure you get appropriate in-person care when needed. So, let’s dive into the world of modern pacing and see how it could improve your or your loved one’s heart function.

2. Cardiac Pacing Basics

To understand CSP versus biventricular pacing, it helps to know some basics about why pacemakers are used in the first place. A pacemaker is a device that sends small electrical signals to your heart to ensure it beats regularly and in sync. Pacemakers are typically recommended when the heart’s own electrical system isn’t doing its job properly – for example, if the heart beats too slowly or if the timing between chambers is off. Two common reasons are:

2.1. Why Some Hearts Need Pacing

Your heart has a natural “wiring” system (the conduction system) that coordinates each heartbeat. Electrical impulses travel from the top chambers (atria) through the AV node and down special pathways (like the His bundle and bundle branches) to make the bottom chambers (ventricles) pump together. If this system is damaged – say from aging, a heart attack, or other conditions – the signal might get delayed or blocked. This can cause bradycardia (too slow heart rate) or uncoordinated contraction of ventricles. Patients might feel fatigued, dizzy, or short of breath because the heart isn’t pumping efficiently. In such cases, a pacemaker can take over as the electrical timekeeper, prompting the heart to beat at an appropriate rate.

Another scenario is heart block, where signals from the atria don’t reach the ventricles properly. A pacemaker can bridge that gap. Essentially, anytime the heart’s rhythm or coordination falters, we consider pacing therapy to keep the blood flowing and symptoms at bay.

2.2. Resynchronization in Heart Failure

Heart failure often comes with a problem called dyssynchrony, especially if there’s a conduction delay like a Left Bundle Branch Block (LBBB). In LBBB, one side of the heart contracts later than the other, making the heartbeat less efficient. Over time, this discoordination worsens heart failure symptoms. Cardiac Resynchronization Therapy (CRT) was developed as a solution to this. Traditional CRT uses biventricular pacing (BVP) – pacing wires stimulate both the right and left ventricles so that they beat together. By resynchronizing the ventricles, CRT can improve the heart’s pumping ability, reduce symptoms, and even help patients live longer in certain types of heart failure. It’s a well-established, life-saving therapy for many people with widened QRS complexes on ECG (a sign of dyssynchrony).

However, CRT with biventricular pacing doesn’t work for everyone. Some patients don’t respond fully, and others can’t get the left-sided lead positioned optimally due to vein anatomy. This is where Conduction System Pacing (CSP) comes into play as an exciting newer approach. CSP aims to engage the heart’s natural electrical highways directly, potentially offering a more physiological way to resynchronize the heart. To appreciate the difference, let’s break down what CSP and BVP really are.

3. Conduction System Pacing (CSP) Explained

Conduction System Pacing is often called “physiological pacing.” The idea is simple: instead of pacing the heart muscle from a random spot, why not pace the heart’s own wiring network? By delivering the pacing impulse into the heart’s conduction fibers (the His–Purkinje system), CSP can activate the ventricles in a natural sequence, as if the heart were stimulating itself. This results in a more coordinated contraction. There are two main techniques under CSP: His-Bundle Pacing (HBP) and Left Bundle Branch Pacing (LBBP).

3.1. His-Bundle Pacing (HBP)

In HBP, the pacemaker’s lead (wire) is implanted at the tiny bundle of specialized fibers just after the AV node, known as the His bundle. Pacing at the His bundle sends the impulse down both left and right bundle branches simultaneously (assuming they are intact), recruiting the heart’s normal pathways. Think of it like fixing the “junction box” of your heart’s electrical wiring. HBP can produce very narrow QRS complexes on the ECG, indicating that the ventricles are being activated almost normally. Patients effectively keep their natural activation sequence, which is great for synchrony.

HBP was the first form of CSP and showed that it’s possible to capture the native conduction system. However, it can be technically challenging. The His bundle is tiny and near the heart’s valves – placing a lead there can be tricky, and sometimes the pacing thresholds (the power needed to stimulate) are high. There’s also a chance the pacing impulse might not always capture if the His bundle has disease or if the lead moves slightly. Despite these challenges, HBP proved the concept that physiologic pacing can prevent the usual discoordination caused by conventional right-ventricle pacing.

3.2. Left Bundle Branch Pacing (LBBP)

Left Bundle Branch Pacing is a newer CSP technique that has quickly gained popularity. Instead of pacing at the His bundle, the lead is screwed a bit deeper into the upper part of the heart’s septum (the wall between the ventricles) to directly engage the left bundle branch area. By doing so, the pacemaker can stimulate the left bundle fibers, which then rapidly conduct the impulse throughout the left ventricle and over to the right side. The effect is a fast, coordinated activation of both ventricles – similar to what HBP achieves, but via the left bundle network.

LBBP (sometimes called LBBAP for Left Bundle Branch Area Pacing) often results in a reliably narrow QRS as well. It tends to have more stable lead placement and lower pacing thresholds compared to HBP, making it a bit easier on the device battery and potentially more durable. Many physicians find LBBP technically easier to perform than pure HBP, because the target area is a bit larger and the lead screws in for a stable position. Over the past few years, LBBP has become a go-to method for physiologic pacing, and it is being used not only for patients with heart block but also as an alternative to CRT in heart failure patients.

In summary, CSP (via HBP or LBBP) tries to restore the heart’s natural order of activation. It’s like repairing the original wiring instead of adding new wires from outside. Now, let’s look at how that differs from the more traditional approach of biventricular pacing.

4. Biventricular Pacing (CRT) Explained

Biventricular pacing is the standard method used in Cardiac Resynchronization Therapy (CRT) for patients with heart failure and electrical dyssynchrony (often LBBB). In a conventional CRT setup, a pacemaker (or defibrillator with CRT capabilities) is connected to two ventricular leads: one in the right ventricle (RV) and another threaded through the coronary veins to sit on the surface of the left ventricle (LV). By pacing both ventricles at the same time, BVP forces the two sides of the heart to contract together. It’s like adding an extra metronome to get both sides of a duet in sync.

4.1. How CRT Synchronizes the Heart

When the CRT device sends an electrical pulse, it stimulates the RV from inside and the LV from outside (via that special vein lead). This dual stimulation can overcome a block in the left bundle branch by directly activating the left ventricle. If one side of the heart was lagging (as in LBBB where the LV is late), now the pacemaker can jump-start that side so it catches up. On an ECG, successful CRT often narrows a previously wide QRS complex (though usually not as narrow as a truly normal QRS). More importantly, patients often feel better over months as their heart beats in a more coordinated way. Pump function can improve and chambers might not dilate as much because the strain of dyssynchrony is relieved.

Biventricular CRT has a proven track record. For eligible heart failure patients (especially those with LBBB and reduced ejection fraction), it can improve symptoms, exercise capacity, and even reduce hospitalization and mortality rates. Many individuals who were short of breath walking across a room can gain a new lease on life after CRT, able to do more activity with less fatigue. That’s why CRT has been a standard of care for advanced heart failure with electrical delays.

4.2. Traditional Benefits and Limitations of CRT

While CRT is fantastic in many cases, it’s not perfect. About 20–30% of patients are considered “non-responders,” meaning they don’t get the improvement we hoped for. Sometimes this is due to scar tissue in the heart, suboptimal lead placement, or simply that the patient’s conduction delay wasn’t the main driver of their heart failure. Placing the LV lead can also be challenging – the heart’s veins might not go to the ideal spot, or the lead might not stabilize well. In some cases, the anatomy prevents reaching the targeted site, and physicians have to compromise on lead position. Also, CRT typically requires a minor surgical procedure under X-ray to thread that LV lead, which can take time and fluoroscopy exposure.

Enter conduction system pacing as an alternative: Instead of pacing the LV from the outside through a vein, CSP paces from the inside through the heart’s own fibers. This could theoretically overcome some limitations (like vein anatomy issues) and maybe capture more of the heart muscle in sync. But how do these two strategies actually stack up against each other? Let’s compare CSP vs BVP head-to-head.

5. Comparing CSP and Biventricular CRT

When we compare Conduction System Pacing to Biventricular Pacing, we’re essentially comparing two philosophies: “fix the wiring” vs “add a new wire.” CSP fixes the wiring by using the His–Purkinje network; BVP adds new wires by pacing two spots in the ventricles. Both aim to achieve the same end result – coordinated ventricular contraction – but they go about it differently. Here are some key points of comparison:

5.1. Procedure and Technology Differences

For CSP (whether HBP or LBBP), the implanting doctor uses a special pacemaker lead that can be screwed into the precise area of the conduction system. They often use real-time electrical measurements (and sometimes imaging) to find the sweet spot where the lead captures the His bundle or left bundle branch. It can be like threading a needle – requiring skill and sometimes a bit of trial and error to get a stable position. The procedure is typically done via a vein access (like a standard pacemaker) and doesn’t require accessing the coronary sinus (the vein for LV leads). So, CSP avoids the need for a left ventricular lead on the heart’s surface. It usually involves placing one lead (for CSP) plus maybe another backup lead in the RV if doing HBP (in case His pacing fails, though often not needed for LBBP).

Biventricular CRT, on the other hand, usually involves placing three leads: one in the right atrium, one in the right ventricle, and one in a vein on the left ventricle’s surface. The third lead (LV lead) is the tricky part – it’s navigated through the veins of the heart using a special catheter, and the doctor tries to lodge it in a branch vein that lies over the left ventricle’s lateral or posterolateral wall (common target areas). This can be time-consuming and sometimes not possible if the anatomy is difficult. The equipment for CRT includes various sheaths and wires for that LV lead. In contrast, CSP typically uses a specialized sheath to aim for the His bundle or septum, but the overall hardware is akin to a standard pacemaker implant.

In terms of procedure time, you might wonder which is quicker. Surprisingly, recent studies and meta-analyses have found no significant difference in the overall procedure duration between CSP and BVP in experienced hands [1]. That means implanting a conduction system pacemaker can be just as efficient as a CRT implant, even though CSP sounds technically challenging. Fluoroscopy time (X-ray usage) also ends up being similar for CSP vs CRT in many reports [1]. As techniques and tools improve for CSP, the learning curve is becoming less of an obstacle.

5.2. Synchrony and Electrical Activation

The whole point of these therapies is to synchronize the heart’s contractions. One way doctors measure synchrony is by looking at the QRS duration on an ECG. A narrow QRS (around 120 milliseconds or less) usually means the ventricles are well-coordinated, whereas a very wide QRS (like 150-180 ms) means delayed activation of part of the heart. Studies have consistently shown that CSP achieves a narrower QRS duration than biventricular pacing does. Essentially, CSP (especially LBB pacing) can often restore the QRS duration close to normal, since it activates the native conduction fibers [1][5]. For example, in patients who underwent AV node ablation for atrial fibrillation (a scenario where pacing is needed 100% of the time), CSP led to QRS complexes about 36 milliseconds shorter on average than BVP – a significant improvement in electrical synchrony[1]. Similarly, in heart failure patients without LBBB, a meta-analysis found CSP’s QRS was ~20 ms shorter than CRT’s on average [2]

Why does this matter? Because a narrower QRS reflects that both ventricles are being activated almost together. With biventricular pacing, although we try to synchronize, the impulse spreads differently – one side from inside-out, the other from outside-in. It improves things but might not perfectly mimic natural activation. CSP, by engaging the His-Purkinje system, tends to result in a more homogeneous activation. This improved electrical synchrony is believed to translate into better mechanical synchrony (the actual squeezing of the heart muscle).

5.3. Immediate vs. Long-Term Effects

Right after implantation, both CSP and BVP will have done their job of pacing the heart. But what about over time? Both approaches aim to prevent heart failure from worsening and to improve cardiac function over months and years. Several studies have looked at changes in left ventricular ejection fraction (LVEF), which is a key measure of heart pump function. CSP has shown at least equal, if not greater, improvements in LVEF compared to biventricular CRT in certain groups. For instance, in patients without LBBB (who sometimes respond less to CRT), CSP led to an average ~5.6% higher improvement in LVEF than BVP in pooled results[3]. In broader comparisons of physiologic pacing vs conventional pacing, CSP has been associated with significant improvements in LVEF and reductions in heart chamber sizes over time [3]. These findings suggest that by pacing more naturally, CSP may allow the heart to pump more efficiently and possibly remodel (reverse some of the dilation) better than traditional pacing methods.

However, it’s important to note that long-term outcomes like survival or hospitalization have not definitively been proven better for CSP yet, largely because we’re still gathering data. Some comparative studies hint at positive trends (like fewer heart failure hospitalizations with CSP), but they haven’t reached clear statistical significance in meta-analyses so far. We’ll discuss more on outcomes shortly with the evidence.[4]

In summary, CSP and BVP both aim to resynchronize a struggling heart. CSP might have an edge in making the heart’s electrical pattern look normal, whereas BVP has decades of evidence and experience behind it. Now, let’s delve into what recent research is telling us about outcomes with these two approaches.

6. Effectiveness and Outcomes: CSP vs CRT

To truly compare CSP and biventricular CRT, we look at outcomes from clinical studies – things like symptom improvement, heart function, and major events (death or hospitalizations). Researchers have been busy over the last few years conducting trials and analyses to see if CSP can match or beat CRT. Here’s what the evidence shows so far, in plain language:

6.1. Electrical Synchrony (QRS Duration)

As mentioned, CSP tends to produce narrower QRS durations on ECG than BVP. In one analysis of patients with atrial fibrillation who underwent AV node ablation (meaning they rely completely on pacing afterwards), CSP resulted in QRS complexes about 35–36 ms shorter than those achieved with biventricular pacing[1]. That’s a sizable difference, given that normal QRS is around 100 ms. Another meta-analysis focusing on heart failure patients without LBBB found a ~20 ms shorter QRS with CSP compared to CRT [2]. Narrower QRS suggests more synchronized electrical activation. This is a favorable sign, since better electrical synchrony often correlates with improved mechanical function (the heart’s squeeze). Indeed, achieving a narrow paced QRS is often one goal of pacing optimization. CSP’s ability to engage the His-Purkinje system directly is largely responsible for this benefit – it paces the heart “from within” the normal conduction network.

In contrast, BVP narrows the QRS from what it was (say, 180 ms down to 150 ms), but rarely gets it all the way to normal. It’s a bit like patching a delay rather than completely eliminating it. So on the ECG front, CSP is looking very promising. But what about things patients actually feel?

6.2. Symptom Relief and Exercise Capacity

Symptom improvement in heart failure is often assessed by NYHA functional class (which ranges from I to IV, with I being mild or no symptoms and IV being severe symptoms at rest). Studies have observed that patients paced with CSP report better symptomatic improvement on average than those with CRT. For instance, in the AF with AV node ablation population, CSP patients improved about half a NYHA class more than BVP patients over time[4]. That might mean, for example, going from class III to class II (from symptoms with minimal activity to symptoms only with more exertion), whereas a CRT patient might improve from III to maybe II–III. Another meta-analysis of various studies found that CSP was associated with a greater reduction in NYHA class overall (meaning people felt less limited) compared to conventional pacing methods [3].

Patients also often report feeling more energetic or having better exercise tolerance with effective resynchronization. While both CSP and CRT can improve this, the edge in narrower QRS and possibly more physiologic contraction with CSP could translate to feeling better. One randomized trial reported that patients with CSP showed similar or improved 6-minute walk distances and quality-of-life scores compared to those with BVP, indicating at least non-inferiority, if not superiority, in functional gains.

It’s worth noting that symptom changes are subjective and can vary widely person to person. But the trend from aggregated data suggests CSP can provide equal if not greater symptomatic relief for patients, especially notable in scenarios where CRT isn’t a home run (like non-LBBB cases or the AF ablation cases).

6.3. Heart Function (Ejection Fraction and Remodeling)

A critical goal in treating heart failure is improving the Left Ventricular Ejection Fraction (LVEF) – essentially how much blood the heart pumps out with each beat. CRT has a well-documented effect of improving LVEF over months by helping the heart beat in sync (some patients see EF improvements of 5-10% or more). CSP likewise has shown positive effects on LVEF. In a meta-analysis of studies focusing on patients without LBBB, those who got CSP had an EF increase about 5.6% higher than those who got BVP[5]. That’s quite significant – for example, if CRT improved someone from 30% to 40%, CSP might get them to ~45%. In the general comparison of physiologic vs conventional pacing, CSP has demonstrated a larger improvement in LVEF with a pooled effect size that is considered a large positive effect [3]. Also, measures of ventricular volumes (like end-systolic volume, which you want to decrease) tend to improve (decrease) more with CSP [3]. Reducing these volumes is a sign of reversed remodeling – the heart getting back closer to normal size and function.

One particular meta-analysis pooling a mix of studies (including both randomized and observational) with over 8,000 patients found that CSP was associated with significant improvements in EF and significant reductions in LV end-diastolic and end-systolic volumes compared to traditional pacing [3]. This suggests that, on average, hearts paced via the conduction system ended up stronger and smaller (healthier shape) than hearts paced via either the right ventricle alone or even biventricularly. The improvement in EF with CSP seemed to grow the longer patients were followed (one analysis noted greater EF gains with longer follow-up periods, hinting that the benefits of CSP might accrue over time) [3].

6.4. Clinical Outcomes (Survival and Hospitalizations)

Now, the big questions: do these pacing methods affect how long people live, or how often they end up in the hospital? These “hard outcomes” take time and large studies to assess. So far, there isn’t conclusive evidence that CSP definitively beats CRT in reducing mortality or heart failure hospitalizations, but the data is encouraging and evolving.

In one meta-analysis of patients with non-LBBB conduction issues, all-cause mortality was lower in the CSP group (relative risk ~0.53, which numerically is almost half), but this difference wasn’t statistically significant given the limited sample sizes[4]. Similarly, heart failure hospitalization rates were lower (RR ~0.54) with CSP but did not reach clear significance[5]What this means in plain terms: in the studies done so far, fewer CSP patients died or had hospitalizations compared to CRT patients, but the numbers of patients were not large enough to say with certainty that it wasn’t due to chance. We need bigger trials to know for sure.

On the other hand, when CSP has been compared to traditional right ventricular pacing (RVP) in people who need pacing (like for AV block), there is clearer evidence of benefit. A recent 2-year study in middle-aged patients who required pacing showed that LBB pacing led to significantly fewer combined heart failure hospitalizations and cardiovascular deaths compared to standard RV pacing (a 22% relative risk reduction over 2 years)[6]. This underscores that pacing in a more natural way (instead of just pinging the right ventricle alone) can prevent some of the long-term complications of dyssynchronous pacing. While this particular study wasn’t CSP vs CRT, it highlights the physiologic advantage of CSP in general. It stands to reason that if CSP can reduce heart failure events versus uncoordinated pacing, it has the potential to at least match CRT’s known benefits, if not exceed them, in certain populations.

In terms of safety, both CSP and CRT have shown comparable complication rates. The risk of infection, lead dislodgement, or procedural complications appears similar between the two approaches based on current data [1]. CSP doesn’t seem to carry extra risk of bad outcomes in the short term. There are some CSP-specific considerations – for example, HBP leads might have to work harder and could increase in threshold over time (meaning the battery has to output more energy to capture the heart). But one meta-analysis found no significant difference in pacing capture thresholds between CSP and BVP on average[4]. Lead longevity and stability in CSP (especially LBBP) have been quite good so far, with low rates of lead failures reported.

To sum up the outcomes: CSP is proving to be at least as effective as biventricular CRT in many respects, with evidence of better electrical synchrony, equal or better symptom improvement, and equal or better improvement in heart function. The big question of mortality/hospitalization benefit remains open, but early signals are hopeful. Large ongoing trials in the U.S. and Europe (with hundreds of patients) should shed more light on whether CSP can actually replace CRT as the first-line approach or if it will be used selectively.

7. Safety and Procedure Considerations

No therapy is without its practical challenges. Here we consider the safety and technical aspects of CSP vs CRT, which can influence a doctor’s and patient’s choice.

7.1. Procedure Complexity and Learning Curve

Biventricular CRT has been around for over 20 years, so many electrophysiologists are very experienced with it. They know how to navigate tricky coronary sinus veins and manage lead placement for the left ventricle. The procedure can take anywhere from 1 to 3 hours depending on difficulty, but it’s well-characterized. Conduction system pacing, by contrast, is a newer skill. It requires the implanting doctor to learn how to find the His bundle or bore into the septum to catch the left bundle fibers. Early on, CSP was considered technically challenging. But as more doctors have gained experience and better tools have been developed (like specialized delivery sheaths and supportive stylets), the success rates of CSP implants have improved significantly. Many centers now report high success in achieving LBB pacing when attempted. HBP is still a bit more finicky due to small target size.

For a patient, the complexity might translate to slightly longer fluoroscopy times initially or the need for an expert operator. However, remember the point from earlier: in comparative studies, the overall procedure time for CSP vs CRT ended up pretty similar on average[8]. This indicates that once the technique is mastered, CSP isn’t necessarily more time-consuming than CRT. If anything, skipping the step of placing an LV lead in a tortuous vein can save time that gets reallocated to fine-tuning the CSP lead position. So, the learning curve is mainly on the physician side, and many are quickly getting up to speed given the interest in physiologic pacing.

7.2. Complications and Risks

The complications from any pacemaker implantation can include infection at the generator site, bleeding or bruising, or lead dislodgement (where a lead moves and loses contact). These risks are present in both CSP and CRT implants. Neither approach shows a higher infection risk inherently – that mostly depends on surgical sterility and patient factors. One difference might be in lead dislodgement: CSP leads, especially LBB leads, are actively screwed into the septum, which gives them a good anchor. LV leads for CRT are often just wedged in a vein branch and held by little tines – occasionally they can dislodge in the first day or two before scar tissue secures them. So one could argue the CSP lead might even be more stable. Overall though, data so far shows periprocedural complications are comparable between CSP and CRT [1]. That means things like heart perforation, significant bleeding, or emergency events are similarly uncommon in both.

One risk unique to CSP, particularly LBB pacing, is the potential to accidentally go too far and perforate into the left ventricle’s chamber or interventricular septum (causing a septal defect or hitting the other side). This is rare and usually avoidable with experience and careful monitoring during the procedure. Another CSP-specific consideration is conduction system injury – ironically, trying to pace the His or left bundle could theoretically damage it and cause a block. But in practice, persistent block caused by placing a CSP lead is infrequent. If HBP fails (like if the His bundle itself is too diseased to capture), often the backup plan is to either move to LBB pacing or just pace the RV conventionally. So it’s important that the implanting center has the ability to adapt if CSP attempt doesn’t pan out.

CRT has its own unique risk: the LV lead in the coronary vein can sometimes irritate the vein or dislodge and cause arrhythmias, or rarely, it can cause a perforation leading to bleeding around the heart (cardiac tamponade). These are known but infrequent issues. Phrenic nerve stimulation is another quirk – sometimes the LV pacing can cause diaphragm twitching if the nerve that controls the diaphragm is too close. Adjusting the lead position or pacemaker settings usually fixes that, but it can be an annoyance. With CSP, phrenic stimulation is rarely an issue because the pacing is deep in the septum, away from the diaphragm nerve.

In terms of long-term safety, one worry some have with CSP is what if the conduction system degenerates further? For instance, if you pace the His bundle and later the patient develops more distal block, would that make the pacemaker ineffective? To mitigate that, doctors often program a “backup” pacing mode or even place a second lead in the RV when doing HBP, just in case. With LBB pacing, even if the proximal conduction worsens, the lead is so far down the pathway that it usually still captures the distal fibers. Nonetheless, ongoing follow-up is needed to ensure thresholds remain acceptable and the patient’s conduction hasn’t changed drastically.

The battery life of the pacemaker can be affected by pacing thresholds. Historically, HBP sometimes had higher thresholds (meaning more battery use) than a typical RV lead. But the difference is often minor, and with LBBP, thresholds are usually low and stable, comparable to a normal pacemaker. So battery longevity on CSP devices implanted today is expected to be similar to any other modern pacemaker or CRT device (often 8-12 years, depending on how much it’s used and the safety margins set).

Finally, think about lead extraction – if a lead gets infected or malfunctions years later, it might need removal. Removing a CSP lead (especially one embedded in the septum) could be slightly more challenging than a standard lead, but only a few cases have been reported and specialized extraction tools can handle it. For CRT, extraction of an LV lead is also non-trivial but doable by experts. These are all factors doctors weigh when recommending one approach over another.

Overall, the safety profiles of CSP and CRT are both good. Neither has glaring risks that the other avoids entirely, and both have specific technical challenges that are manageable. It often comes down to the patient’s specific situation and the implanter’s expertise.

8. Who Can Benefit from CSP or CRT?

Not every patient with a pacemaker indication will need or benefit from conduction system pacing or CRT – it depends on their condition. Let’s outline the scenarios where each approach is considered, and how doctors choose between them:

8.1. Patients with Heart Failure and LBBB

If a patient has heart failure with reduced ejection fraction (HFrEF) and a classic left bundle branch block (wide QRS, typically ≥150 ms with that characteristic pattern on ECG), traditional CRT with biventricular pacing is a Class I guideline-recommended therapy. These are the folks who have the most to gain from resynchronization – CRT has been shown to improve survival and reduce hospitalizations in this group. For such patients, CRT has been the default for years. Now, could CSP be used here instead? Possibly yes. Some early trials and observational studies suggest that CSP can also help LBBB patients and maybe achieve even narrower QRS than CRT. There have been small randomized trials (some cited in the meta-analyses above) where patients with LBBB were given either LBB pacing or BVP and both groups improved, with CSP showing non-inferiority and sometimes better acute metrics like QRS narrowing [5]. We are awaiting results from larger trials (like one called “LBBP-RESYNC” and others) specifically in classic CRT candidates.

For now, many physicians might still lean on CRT for a wide LBBB patient because it’s tried-and-true, especially if the center isn’t yet fully comfortable with CSP. But at specialized centers, CSP is being offered as an alternative even for these typical CRT candidates, on a case-by-case basis. If you’re a patient in this category, the good news is you likely have two viable options to resynchronize your heart. An electrophysiologist can evaluate whether you’d be a good candidate for CSP (for example, is your septum accessible, any scarring there, etc.) or if standard CRT is the straightforward choice.

8.2. Patients with Non-LBBB Conduction Delays (RBBB or IVCD)

Heart failure patients with a non-LBBB pattern (like a right bundle branch block, RBBB, or a nonspecific intraventricular conduction delay) historically have had less success with CRT. The benefit is still there, but not as pronounced as with LBBB. In fact, some insurance or guidelines have been stricter on offering CRT to non-LBBB patients unless the QRS is very wide, because the expected improvement is smaller. This is exactly where CSP might shine. Because CSP can directly recruit the Purkinje system, it doesn’t rely on the pattern being LBBB or not – it can potentially correct both RBBB and left-sided delays by pacing downstream of the block.

The meta-analysis by Pung et al. looked at this subgroup (non-LBBB HFrEF) and found CSP led to better EF improvement than CRT[5] So for patients with, say, RBBB and heart failure, a doctor might consider CSP as a primary option. Anecdotally, some patients who failed to respond to CRT (perhaps because their pattern was atypical) have later been switched to CSP with good results. This is still an evolving area, but it’s logical: if CRT wasn’t designed for that electrical pattern, maybe a more physiological pacing like CSP can do better.

If you have heart failure but your ECG doesn’t show the classic LBBB, you might be in this category. It would be worth asking a cardiologist about CSP as an option. On Doctors365, you could find a cardiology specialist [Dr. John Smith — Cardiology — /doctors/cardiology/dr-john-smith/] or even an electrophysiologist [Dr. Jane Doe — Cardiac Electrophysiology — /doctors/cardiology/dr-jane-doe/] who is knowledgeable about these new pacing therapies to review your case. They can explain if conduction system pacing could be beneficial for you as opposed to (or in addition to) standard treatments.

8.3. Atrial Fibrillation Patients Undergoing AV Node Ablation

There’s a specific scenario in arrhythmia management: patients with atrial fibrillation (AF) who can’t get their heart rates under control with medications. One strategy is to do an AV node ablation – basically create a block so the AF can’t cause a fast ventricular response – and then implant a pacemaker to maintain the heart rate. This “pace-and-ablate” strategy can relieve symptoms of AF (no more rapid pulse swings, as the pacemaker keeps things steady). Traditionally, the pacemaker lead would pace the right ventricle in these cases. But prolonged RV pacing can induce dyssynchrony and potentially lead to a form of heart failure over time. So here, resynchronization is important even if the patient doesn’t have classic heart failure yet.

CSP has emerged as a great option in AF ablation patients. The meta-analysis by Mavilakandy et al. focused on exactly this scenario – AF patients who got AV node ablation and pacing – and found that those who received CSP had better outcomes than those who received BVP. The CSP group had narrower QRS and better NYHA class improvement[4]. Even though LVEF changes were similar (with a slight trend favoring CSP), the symptomatic benefit was notable[5]. This implies that if you need to be paced 100% because of AV node ablation, doing so through the conduction system (HBP/LBBP) keeps your heart more in sync than a biventricular pacer would. In practice, many EP specialists now consider CSP the preferred pacing method for a pace-and-ablate AF patient, especially if they didn’t already have a CRT device. It’s a way to ensure the heart continues to beat as naturally as possible despite the AF.

So if you or someone you know is struggling with AF and considering AV node ablation with a pacemaker, be aware of this distinction. It’s worth discussing whether conduction system pacing could be used for the pacemaker component to maintain better heart function long-term.

8.4. Other Scenarios (AV Block, Upgrades, etc.)

Beyond heart failure and AF, CSP is being explored in many other scenarios:

• Standard AV Block in younger patients: If someone has a slow heart rate due to AV block and needs a pacemaker, especially if they are young or expected to need pacing for many years, CSP might avoid the risk of pacing-induced cardiomyopathy that sometimes happens with decades of RV pacing. The recent trial we mentioned (TREEBEARD registry) in middle-aged patients showed LBBP was better than RV pacing at preventing heart failure events[3]. This has led to a paradigm shift where physiologic pacing is being considered even for routine pacemakers in those who are active or have a long life expectancy.
• Upgrading from RV pacing: Patients who have had a regular pacemaker for years and then develop heart failure or their EF drops – some of those are now being upgraded to CSP instead of CRT. Historically, you’d upgrade to a CRT device (adding an LV lead). Now, a doctor might choose to add a lead for HBP or LBBP instead, to restore synchrony.
• Pediatric or congenital heart patients: This is a more niche area, but pacing in congenital heart disease can be challenging due to anatomy. CSP might offer new solutions, but it’s still early and case-by-case.
• Patients with narrow QRS but severe heart failure: There’s interest in whether pacing could help heart failure patients who don’t have a wide QRS. Traditional CRT doesn’t work if QRS is narrow (no dyssynchrony to fix). But what if we paced those patients with CSP at a slightly higher rate, or in a coordinated way? This is largely experimental at this point, but some think CSP might one day have a role in heart failure beyond the electrical delays – essentially as a therapeutic pacing strategy to optimize contraction timing even when QRS isn’t very wide. This remains to be proven.

In all cases, the decision to use CSP or CRT is individualized. Factors include: the anatomy (can the leads be placed successfully), the patient’s specific electrical pattern, and the availability of technology/expertise. The good news is that, through platforms like Doctors365, you can easily get a second opinion from a specialist if you’re unsure. For example, [Dr. Richard Roe — Heart Failure Specialist — /doctors/cardiology/dr-richard-roe/] is one of the Doctors365 experts in managing advanced heart failure and device therapy – he could evaluate your case and help determine the best course, whether it’s CRT, CSP, or another treatment.

9. Limitations and Challenges of CSP

Conduction system pacing is exciting and promising, but it’s not without its challenges. Before everyone jumps on the CSP bandwagon, there are a few gaps in understanding and practical considerations to acknowledge. This section highlights some limitations of CSP as of today (which ongoing research is trying to address).

9.1. Evidence and Long-Term Outcomes

One major gap is the relative lack of large, long-term randomized trials comparing CSP to CRT on outcomes like survival. As we discussed, the preliminary data from meta-analyses of small trials and observational studies is positive. But cardiology guidelines typically rely on big trials to make firm recommendations. CSP is still awaiting those definitive trials. Until then, some providers may be cautious in replacing CRT wholesale with CSP, especially when CRT’s benefit is well-established for certain patients. We need more data on 5-year, 10-year outcomes with CSP: Do those patients stay out of the hospital more? Do they live longer or the same? Are there any late complications unique to CSP? The field is rapidly evolving, and within the next 5 years we expect a lot more published evidence. But as of now, CSP has not fully reached guideline parity with CRT – it’s more of an emerging therapy backed by early and mid-term studies. Regulatory approvals of leads specifically for CSP are also catching up; currently, many CSP implants use leads off-label (originally designed for standard pacing) because dedicated CSP tools are only gradually coming out.

9.2. Technical and Training Challenges

We mentioned the learning curve – this is a limitation in the sense that not every hospital or pacemaker implanting doctor has ample experience with CSP yet. If you’re in a region where nobody does CSP, you might not be offered that option until the local physicians get training or referral to a specialized center is made. The flip side is, training programs and workshops on CSP are widespread now, so the knowledge is spreading fast among cardiologists. Still, a patient considering CSP may want to ask, “How many of these have you done?” to ensure their doctor is comfortable with it.

Another technical point: verifying that you actually captured the conduction system can sometimes require careful analysis of the ECG or electrical signals during implant. There are specific criteria (e.g., certain patterns on the ECG when pacing that confirm you’re in the His or left bundle). There’s ongoing work to standardize these criteria. Right now, terms like “selective vs non-selective His capture” or what defines true left bundle capture can be a bit academic. For the patient, what matters is the outcome (QRS narrowing, etc.), but for clinicians, having clear definitions helps ensure consistency. The field is working on consensus guidelines for what counts as successful CSP placement.

9.3. Follow-Up and Lead Management

CSP leads, particularly in the septum, may behave a little differently over time. HBP leads sometimes show a rise in pacing threshold after a while (maybe due to fibrous tissue around the His bundle). LBBP leads generally have been stable, but it’s relatively new, so we have to see how they perform over, say, 10+ years. If a threshold rises too much, that could shorten battery life or require lead revision. So far, data indicates stable performance of CSP leads and not significantly more generator changes than CRT devices [1][5], which is reassuring.

Extraction of an old CSP lead, as noted, is a special situation. If years later a lead needs to come out (due to infection or malfunction), extraction specialists might need to carefully work on the septal portion. The success of extractions should be high with proper tools, but since CSP leads “grip” the septum, they might be a bit more ingrown than a typical RV lead that lies passively. This is just something to keep in mind – it’s more of a concern for the medical team than the patient, but it factors into long-term management strategies.

9.4. Not for Every Situation

While CSP is great, there are instances where it might not be feasible or optimal. For example, if a patient has a lot of scar tissue in the septum (maybe from a past heart attack or an infiltrative disease), the conduction system might be damaged or inaccessible. In such cases, even if you place a CSP lead, it might not capture effectively. These patients might do better with a traditional CRT approach where you pace around the scar. Another scenario: if someone has a congenital anomaly of the conduction system or a very unusual heart anatomy, CSP targets might not be where you expect them. Biventricular pacing might be simpler and more assured in those cases.

There’s also patient preference and clinical judgment. Some patients might be enrolled in remote monitoring programs that are very tailored for CRT devices (like special heart failure monitoring features). CRT devices often come in combo with defibrillators for those who need it, whereas CSP can be done with defibrillator too, but again not as mainstream yet. So, if a patient needs a defibrillator (ICD) and CRT, doctors might consider doing a CRT-D device vs trying an ICD with CSP pacing – both can be done, but CRT-D is the standard. It will depend on comfort level and the specifics of the case.

The bottom line on limitations: CSP is a fantastic development but not a magic fix for every patient. It requires expertise, careful patient selection, and more evidence for widespread adoption. However, it’s quickly moving from experimental to more routine in many centers. We’re essentially witnessing a potential paradigm shift in pacing. Just as CRT revolutionized care 20 years ago, CSP might further refine it in the coming decade.

10. The Future: Will CSP Replace CRT?

Many patients and doctors are asking this question. The honest answer: It’s possible that one day CSP will become the default for most cases that currently get CRT, but we’re not fully there yet. More likely, we will see a personalized approach. The future might look like this:

For some patients, traditional CRT (BVP) remains the best – maybe those who can’t get a CSP lead to capture well, or those with certain anatomies. For many others, CSP could be the first choice due to its physiologic benefits. It’s not so much a competition as it is an expansion of our toolkit. Having both options is great, because if one doesn’t work optimally, the other can be tried. In fact, there are already hybrid devices being used: for example, a patient might receive an LBB pacing lead and an LV lead (biventricular) and the device can be programmed to use one or the other or even both in a “his-optimized CRT” fashion. This was explored in research known as “HOT-CRT” (His Optimized CRT), where they essentially use HBP and BVP together to ensure capture of conduction plus extra kick if needed. Early studies showed it’s feasible and can be beneficial especially if His capture thresholds rise – the device automatically switched to BVP as backup.

What about guidelines and official endorsements? As evidence builds (like the meta-analysis of RCTs [5] showing clear benefits in QRS, EF, etc.), professional societies will incorporate CSP into guidelines. We might see recommendations such as: “CSP should be considered as an alternative to CRT in patients with indications for resynchronization, especially in those who are non-responders to CRT or have contraindications to the transvenous LV lead.” There might also be more emphasis on training new electrophysiologists in CSP techniques as part of their standard curriculum.

Technology will also drive the future. We expect to see new pacing leads designed for CSP – perhaps with better helix design for septal screwing, or electrodes that can capture selective tissue more easily. Imaging tools might integrate (like using 3D mapping or improved echocardiography during implant) to guide lead placement precisely. In time, an implant might be done with a navigation system that highlights the target area for LBB capture. These advances will make CSP more reproducible and reduce the dependence on individual operator skill.

One can’t mention the future without noting the ongoing research. A number of randomized trials are underway comparing LBB pacing vs CRT in various populations. There’s also interest in using CSP in conditions like cardiomyopathy with narrow QRS (as mentioned), and even in pacing the left bundle branch in hypertrophic cardiomyopathy or other diseases to see if it can reshape the contraction pattern beneficially. We might find new indications for pacing we hadn’t thought of, thanks to CSP’s ability to engage the heart’s natural system.

In summary, CSP has gone from an experimental idea to a mainstream option in a remarkably short time. As Dr. Srinath Yeshwant and Dr. Gaurav Upadhyay (pioneers in the field) noted, it’s been a rapid evolution but still has “gaps in understanding” that need to be filled with rigorous studies [4]. The likely scenario is coexistence and complementarity: CSP will replace CRT in some cases, augment it in others, and push the boundaries of how we use pacing to treat heart disease. For patients, this is great news – it means more tailored therapy and hopefully better outcomes in the long run.

Now, having covered the technical side of things, let’s shift gears. If you or a loved one has heart failure or needs a pacemaker, how can you leverage telemedicine to navigate these options? The next sections will cover how an online consultation can help and why Doctors365 might be the convenient platform to connect with top heart specialists.

11. How an Online Cardiologist Can Help

Dealing with a complex heart condition or facing a decision about getting a pacemaker can be overwhelming. Traditionally, you’d have multiple in-person appointments: with your cardiologist, with an electrophysiologist (a heart rhythm specialist), maybe even a surgeon. But in the digital age, you have the option to start those conversations from the comfort of your home. Online cardiologist consultations, like those offered through Doctors365, can be incredibly helpful, especially in the early stages of decision-making and for follow-up care. Here’s how an online heart doctor can assist you:

11.1. Initial Consultation and Second Opinions Online

Suppose your doctor has told you that you might need a pacemaker or CRT device. It’s a good idea to understand all your options – maybe you’ve heard of CSP and want to know if it’s right for you. Through an online consultation, you can get a second opinion or detailed explanation without traveling to a specialty center. You could schedule a video visit with a cardiologist or electrophysiologist who has expertise in device therapy. They can review your medical records, ECG, and echo results (you can usually upload these beforehand on platforms like Doctors365). During the video call, the doctor can explain in plain language what your condition is and how something like CRT or CSP would help. You can ask all the questions you might not have had time for in a rushed clinic visit.

For instance, an online specialist might walk you through your ECG, pointing out the LBBB or other conduction issue, and explain how a device might fix it. They could discuss the pros and cons of CSP vs CRT as it pertains to your case. If you’re a candidate for both, they’ll help you weigh factors like the center you’d go to and the evidence available. If you’re leaning toward CSP but your local hospital doesn’t offer it, the online doctor could even help guide you on how to get referred to a center that does, or perhaps coordinate with your local cardiologist to consider it. This kind of collaborative care is increasingly possible with telehealth – the online doctor isn’t replacing your in-person doctor, but rather augmenting your understanding and helping chart the best course.

Patients often find second opinions empowering. You might discover that another expert fully agrees with your doctor’s plan (giving you peace of mind), or they might suggest an alternative approach (giving you new options to consider). Either way, it’s valuable input. And doing it online saves you the trip, the waiting room time, and usually you can get an appointment sooner than some in-person visits would be. Doctors365, for example, allows you to browse profiles of cardiology specialists, see their subspecialties and expertise, and book a time that suits you – sometimes as soon as the same day or next day for urgent questions.

11.2. Follow-Up Care and Remote Monitoring

If you’ve already undergone a procedure – say you got a CRT device implanted – you’ll need periodic follow-ups. Some of these follow-ups can absolutely be done online. After a pacemaker or CRT implantation, patients typically have a wound check and a device check at 1-2 weeks, then 3 months, etc. The wound check could even be visualized over a video call (you can show the doctor your incision). Device checks are often done remotely these days with a home transmitter that sends data from your device to the clinic. If that’s set up, the results can be reviewed during a telehealth visit. The doctor can tell you, “Your device shows you’re pacing X% of the time, your battery status is good, no alerts triggered.” You can then discuss how you’re feeling and adjust medications if needed, all without an office visit.

For heart failure management, telemedicine is a boon. You can report your weights, blood pressure readings, symptoms like swelling or breathing difficulty, and a doctor can tweak your diuretics or other meds in real time. This could potentially prevent a hospitalization by addressing warning signs early. If you have a conduction pacemaker in (CSP) or CRT, the doctor might ask about improvement in exercise capacity or any new symptoms. Many issues can be handled through conversation and maybe an order for a lab test at a local facility if needed.

Of course, not everything can be done remotely. If you have a device issue that requires reprogramming or if you need an ultrasound of your heart, you’d still go in person. But an online follow-up can triage and determine that. Perhaps 70-80% of routine follow-up questions can be resolved via telehealth, which saves you time and energy (especially important for heart failure patients who may have limited mobility).

On Doctors365, after your consultation, the doctor provides a summary of the visit, which you can refer back to. They may also include any recommended next steps (like “get a blood test in 2 weeks” or “see local cardiologist for an echo in 3 months”). If any prescriptions are needed, they can e-prescribe to your pharmacy when appropriate. While they can’t do things like implant a device online (naturally), they can manage the preparatory and maintenance phases around it efficiently.

In short, online cardiology consultations can guide you through complex decisions and help manage your heart condition over time. They offer convenience without sacrificing the quality of interaction – in fact, many patients find doctors take extra time to explain things on a video call since they’re in a comfortable environment with fewer clinic interruptions. With that in mind, let’s talk specifically about how the Doctors365 platform works and what makes it patient-friendly.

12. How Doctors365 Works for Cardiology Consultations

Using Doctors365 to access heart specialists is straightforward and designed to put you in control of your healthcare journey. If you’re new to online medical visits, here’s a step-by-step of what to expect and how our platform ensures a smooth experience:

12.1. Easy 5-Step Appointment Process

1. Browse and Choose a Doctor: Start by exploring the list of available doctors on doctors365.org. You can filter by specialty – for example, select “Cardiology” to see all heart specialists, or even filter further to “Electrophysiology” if available. Each doctor’s profile will show their qualifications, subspecialties, years of experience, and patient reviews. Let’s say you find [Dr. John Smith — Cardiology — /doctors/cardiology/dr-john-smith/] who has 15 years of experience with heart failure and device therapy – you can click on his profile to learn more.
2. Select a Time Slot: Once you’ve picked a doctor, you’ll see their available appointment times. Doctors365 offers 24/7 availability, meaning some doctors have evening or weekend slots. Choose a time that suits you. If it’s a non-urgent matter, maybe you schedule for the next day after work; if it’s more urgent, you might find someone available within hours.
3. Book and Pay Securely: After selecting the time, you’ll go through a quick booking process. You’ll provide a brief reason for the visit (e.g., “Discussion about pacemaker options” or “Heart failure follow-up”). Then you’ll proceed to payment. Doctors365 is transparent about costs – you’ll see the consultation fee upfront. There are no surprise charges. Payment is done through a secure system, and many providers on the platform may offer insurance reimbursement receipts if your insurance covers telehealth. (Costs can vary by provider, but you can see the price tag as you browse doctors. Some follow-up visits or shorter check-ins might be offered at a lower rate by the same provider, which is a bonus for ongoing care.)
4. Join the Secure Video Session: At your appointment time, you log in and join the virtual waiting room. The session is conducted via a secure, encrypted video call built into the Doctors365 platform – no need to download special software; it can work through your web browser or the mobile app. The connection is private and HIPAA-compliant, meaning your health information is protected. When the doctor joins, you’ll see and hear each other just like a Zoom or FaceTime call, but on a platform tailored for healthcare (with ability to show documents, etc.).
5. Consultation and Follow-Up: During the visit, it’s just like an in-person consultation except you’re at home. The doctor will take a history, possibly ask you to show something on camera (like swelling in your ankles or an incision site). They might share their screen to show you diagrams or your lab results. Once the consultation is done, you’ll receive a visit summary in your account. If the doctor wrote any prescriptions or referral letters, those will be included or sent to you. You can also message the office through the platform if you forgot to mention something (some doctors allow a brief follow-up message for clarification).

12.2. Verified Specialists and Secure Platform

One of the key benefits of Doctors365 is the quality and verification of the doctors. Every specialist on the platform is fully licensed and verified. Their credentials are checked, and many are board-certified in their field. You’ll notice on profiles details like “Board Certified in Cardiology” or specific expertise like “Heart Failure Specialist” or “Electrophysiologist.” We pride ourselves on having a roster of top-notch professionals, ranging from experienced attendings at major hospitals to professors and even some recognized leaders in their specialties.

Additionally, patients can leave ratings and reviews after consultations (much like you might rate an Uber ride or a product online). This helps maintain transparency – you can see if a doctor is consistently rated highly for communication, knowledge, helpfulness, etc. It also gives you confidence that others have had good experiences. For instance, [Dr. Jane Doe — Cardiac Electrophysiology — /doctors/cardiology/dr-jane-doe/] might have numerous 5-star reviews noting how clearly she explained pacemaker options and how patient she was with questions.

Security is paramount: all communication through Doctors365 is encrypted. Your medical data, records, and any images or test results you upload are stored securely. Privacy policies comply with healthcare regulations, so your information is only shared with those you permit (like the doctor you consult).

Finally, after your consultation, you have the flexibility to either stick with that doctor for follow-ups or try different specialists as needed. Your account keeps a history of past consultations and notes, which any new doctor (with your permission) can review to get up to speed. This continuity is great – it means you won’t always have to re-explain everything from scratch, especially if you use the platform regularly for your healthcare.

In summary, Doctors365’s platform is built to make accessing healthcare as simple, safe, and convenient as possible. In the next sections, we’ll highlight the benefits of this approach and why so many patients are choosing online consultations, especially for chronic conditions like heart failure where frequent check-ins are useful.

13. Benefits of Online Cardiology Care

Why bother with online care when you could go in person? It turns out, telemedicine offers some unique advantages, particularly for managing ongoing conditions such as heart problems. Here are some of the key benefits you’ll enjoy by consulting cardiologists through Doctors365:

13.1. Anytime, Anywhere Access

One of the biggest draws is the ability to get care 24/7 from anywhere. If you live in a remote area or far from a major heart center, telemedicine erases that distance. You can connect with a top cardiologist in a big city while you’re sitting in your living room miles away. There’s no travel time, no dealing with traffic or arranging rides. For patients with heart failure who may get easily fatigued by travel, this is a huge relief. Also, because online providers often have flexible hours, you can find help on weekends or evenings. Heart symptoms and questions don’t always arise Monday to Friday, 9-5. Maybe you start feeling more short of breath on a Friday night – instead of waiting nervously until Monday to call your doctor, you could hop on Doctors365 and see if a cardiologist is available Saturday morning to discuss what to do. That kind of timely access can prevent complications.

13.2. Comfort and Privacy

Seeing the doctor from your own home can be a lot more comfortable. You can wear whatever you want, sit in your favorite chair, and not worry about hospital vibes or waiting rooms. For some people, this relaxed setting makes it easier to open up about symptoms or concerns. There’s also a sense of privacy – no chance of bumping into someone you know in a waiting room if that’s something you worry about. And rest assured, the technology is encrypted and secure (as discussed), so your medical conversation is private. Some patients also appreciate that family members can easily join the tele-visit if you want them to (maybe a spouse listening in or an adult child who lives out of town but wants to be updated on your health – they can dial in too from another location, with your permission). This kind of group communication is simpler with virtual visits than all trying to fit into a doctor’s office in person.

13.3. Save Time and Money

Think of the time you save: no driving, no parking, no sitting in a waiting room past your appointment time. A lot of appointments (especially follow-ups) are short, maybe 15 minutes of face time with the doctor. Yet you might have spent an hour or two in transit and waiting for that. Telehealth gives you back that time. It’s literally a few clicks and you’re there. This can reduce time off work or away from other responsibilities too.

Financially, while there is a fee for the consultation, you save on all those incidental costs – gas, parking fees, maybe childcare if you had to get someone to watch the grandkids while you went to the doctor. Plus, many telehealth consultations are competitively priced, sometimes cheaper than an urgent care visit. And preventing a hospitalization or ER visit by addressing an issue early via telehealth is a massive cost saving in the bigger picture.

Some insurers nowadays cover telemedicine or have it integrated into their plans because they recognize it can reduce expensive in-person services. Always check your policy; if not, Doctors365 still provides receipts that you might submit for possible reimbursement or HSA/FSA usage. Regardless, the transparency in pricing means you know what you’ll pay upfront. No mysterious bills arriving later (we’ve all heard those healthcare billing horror stories – not a concern here).

13.4. Continuity and Coordination of Care

When using an online platform regularly, you build a relationship with the doctors. For chronic issues, you might consistently follow up with the same cardiologist who gets to know you. This continuity is just as valuable as in-person relationships. They can track your progress, recall your history, and personalize advice. If you do need in-person intervention (like you decide on getting a pacemaker), the online doctor can even help coordinate that by referring you to a trusted colleague or center, and then continue to follow up with you after the procedure.

All your notes and records from each online visit are stored in one place that you can access. So if you forget what that doctor recommended last month, you can log in and read the summary again. No need to rely on memory or scribbled notes. You can also share those summaries with your primary care provider or local cardiologist to keep everyone in the loop – it’s as simple as downloading or forwarding the document. This means your care remains collaborative. Telehealth isn’t meant to isolate you from your regular doctors; it’s an added layer of support that can enhance overall coordination.

In essence, online care via Doctors365 provides convenience, efficiency, and a supportive network of specialists at your fingertips. It complements traditional care beautifully by filling gaps (like after-hours questions or ease of getting second opinions). It’s healthcare designed around your life, rather than the other way around. Next, we’ll emphasize the quality assurance piece – why you can trust the doctors on the platform and the safeguards in place.

14. Quality, Security, and Trust on Doctors365

When it comes to health, trust is everything. We’ve touched on how Doctors365 vets its specialists and secures its platform. Now let’s go a bit deeper into why you can feel confident using it for something as critical as cardiology consultations:

14.1. Certified and Vetted Cardiologists

All Doctors365 physicians go through a rigorous credentialing process. This means their medical licenses are verified for authenticity and good standing. Many will list their board certifications (e.g., Board Certified in Cardiovascular Disease, or even a sub-board in Clinical Cardiac Electrophysiology). Board certification is a stamp of expertise – it means the doctor has not only completed specialty training but also passed a comprehensive exam in that field. On top of that, experience matters. The profiles often mention years of practice or special roles (like “Former Chief of Cardiology at XYZ Hospital” or “Fellow of the American College of Cardiology”). We encourage doctors to highlight any particular achievements or research, especially if relevant to the topic – for example, a doctor might note they participated in a clinical trial for a new pacemaker lead.

As a patient, you have the power to choose who you see. Some patients prefer a doctor who has, say, 20+ years of experience. Others might be fine with a younger doctor who’s perhaps more recently trained in the latest techniques. The point is, you have visibility into who is treating you, more so than you might when you’re assigned a random on-call doctor in a clinic or hospital. And if for any reason a consultation didn’t meet expectations, the review system holds providers accountable (consistently poor reviews would be addressed by our team and could lead to removal from the platform – thankfully that’s a rare scenario as we select high-caliber professionals to begin with).

14.2. Patient Reviews and Transparency

We believe in transparency to build trust. After each consultation, patients can rate their experience and leave comments. This feedback isn’t hidden – it’s there for others to see. It helps new patients get a feel for a doctor’s communication style and expertise. For example, a review might say, “Dr. Doe was very thorough in reviewing my case and answered all my questions about CRT vs CSP. I felt much more confident about my treatment plan after our talk.” Such firsthand accounts can reassure you that you’ll be in good hands.

Transparency also extends to pricing (as discussed) and to the platform’s operations. If a doctor has any particular rules (like maybe they can’t prescribe certain controlled medications via telehealth, which is a common regulation), that is usually communicated up front. The aim is no surprises – you know what you’re getting and the limits of the service.

14.3. Secure and Confidential Communication

We cannot stress enough how seriously we take privacy. Medical information is sensitive, and we use top-tier encryption for both stored data and live video streams. It’s the same level of security that banks use for financial information, applied to your health info. Also, our privacy policy is compliant with healthcare laws (like HIPAA in the US), meaning we don’t sell your data or use it inappropriately. Only those involved in your care (you and the doctor, or a care coordinator if needed) can access your consultation details.

There’s also a commitment to clinical governance and ethics. Doctors on the platform adhere to telemedicine guidelines, which include knowing when to tell a patient, “You need to go to the ER” or “This requires an in-person exam.” They won’t string you along for issues that cannot be addressed online. For instance, if during a video consult it becomes clear you’re in distress or something urgent is brewing, they will direct you to immediate care and can even help coordinate that (like calling ahead to an ER to expect you). This ensures that using telehealth doesn’t compromise safety – in fact, it can expedite getting the right level of care.

We also keep an eye on outcomes. There are internal reviews where we might follow up on cases (with patient consent) to see how everything went, ensuring quality stays high. Continuing education is encouraged – many of our specialists are actively engaged in learning the latest in their field, so when you ask about a new therapy like conduction pacing, they’re well-informed (many contributed to or at least keep up with research like the studies we cited here!).

In short, Doctors365 marries the human touch of experienced, caring doctors with the reliability of a well-designed tech platform. We want you to not only receive excellent medical advice but also to feel safe and respected throughout the process. Next, we’ll help you understand when it’s appropriate to use telemedicine and when you absolutely should go in person, so you can make the best decision for your health at any given moment.

15. Online vs. In-Person: Knowing the Limits

It’s important to recognize what can and cannot be handled via an online consultation. Telemedicine is fantastic for many situations, but it doesn’t replace the need for hands-on care in emergencies or certain procedures. Here’s a clear guide to help you decide:

Use Online Consultation For:

• General Advice and Education: If you have questions about treatments (like “Should I consider CSP versus CRT?”), or you want a better understanding of your condition, an online visit is ideal. The doctor can spend time educating you without the rush of a busy clinic day.
• Second Opinions: As discussed, getting another expert’s view on a diagnosis or treatment plan is easy online. You can share your records and get that input without traveling.
• Routine Follow-ups: If you’re managing heart failure, hypertension, a stable arrhythmia, etc., many follow-ups involve talking, adjusting meds, reviewing symptoms – all doable remotely. For device patients, as long as the device can be interrogated remotely, the follow-up discussion can be virtual.
• Reviewing Test Results: Want to go over your latest echo or lab results? An online doc can pull it up and walk you through it. Sometimes this is quicker than scheduling an in-person visit just to hear “your results look stable” or “we need to tweak this.”
• Minor Symptoms or Uncertainties: Maybe you feel a bit more short of breath than usual but not severely so, or you have palpitations that come and go. An online doc can evaluate and advise if this is something to watch, medicate, or get checked in person. They can also prescribe further testing if needed (e.g., order blood tests, arrange for you to get a Holter monitor, etc., which you’d do locally but as a result of the online consult).

Go In-Person For:

• Emergencies: This bears repeating – chest pain that might be a heart attack, sudden severe shortness of breath (could be pulmonary edema), signs of stroke, fainting episodes, or anything that you feel is acutely worsening – these are not for telemedicine. An online doctor cannot perform CPR, give IV meds, or do emergency imaging. In these cases, call emergency services or go to the nearest emergency department. If you mistakenly come to an online visit in an emergency, the doctor will likely direct you to ER immediately (which could waste precious minutes), so it’s best to identify emergencies upfront.
• Procedures and Tests: If you clearly need a procedure – e.g., you’ve decided to get a pacemaker, or you need a stress test – those obviously require in-person scheduling. An online doctor can help coordinate or refer, but the actual service will be at a facility. Similarly, physical exams that matter (like listening to your heart/lungs, checking your ankles for fluid) can’t be done virtually to the same extent.
• Situations Requiring Touch/Feel: For example, if you have a questionable lump or skin change (say an ICD pocket infection concern), a doctor might need to palpate it. While video can show some, it’s not foolproof. The online doc might advise you to go in person in such cases.
• Complex imaging on the spot: If you need an immediate echocardiogram or urgent catheterization, etc., you must be at a facility. Telemedicine is not a solution for that immediate level of intervention.

Red-Flag Symptom List:

• Severe, crushing chest pain or pressure, often with sweating or nausea – could be a heart attack (Call emergency services).
• Sudden onset of difficulty breathing, especially if you’re pale or lips turning blue – could be acute heart failure or clot in lung (Emergency!).
• Fainting (syncope), especially with exertion or accompanied by palpitations – needs prompt evaluation (ER or urgent clinic).
• Sudden severe dizziness or weakness on one side of the body (sign of stroke) – ER, not telehealth.
• Rapid heart rate >150 that doesn’t slow down, with feeling faint – could be a dangerous arrhythmia (requires in-person urgent care).

Remember, telehealth doctors are trained to spot these red flags when you describe symptoms. They will err on the side of caution. If they say you need to go in, it’s not because they don’t want to help you – it’s because they recognize the limitations of what can be done remotely for your safety.

For everything else, telemedicine can be a strong ally. It’s about using the right tool for the right situation. Many times, an online consultation can clarify whether something is truly urgent or not, saving you unnecessary ER trips. Conversely, if urgent, the tele-doc will expedite you getting care.

By understanding these boundaries, you can confidently use Doctors365 to the fullest extent appropriate, and transition to in-person care seamlessly when needed.

16. Costs and Availability of Online Heart Consultations

One common question is: how much will this cost, and can I get an appointment when I need it? We touched on cost transparency earlier, but let’s break it down, and also talk about availability of services on Doctors365:

• Cost Structure: Each doctor on Doctors365 sets their consultation fee, often based on session length or expertise. You might see prices like $XX for a 15-minute consult, $YY for 30 minutes. Specialists may charge a bit more than generalists, which is expected. However, these fees are displayed upfront, so you can make an informed choice. There are no hidden fees – the price covers the consultation and the follow-up summary, etc. If you need a prescription, you pay for that at the pharmacy as usual, but there’s no extra charge from the doctor for writing it. If the doctor recommends a follow-up in a few weeks, that would be a new appointment (unless they specifically offer a bundled plan). But often, virtual follow-ups might be shorter/cheaper than initial visits, especially if it’s just to check progress or lab results.
• Insurance and Savings: Depending on your region and insurance provider, telehealth visits might be reimbursable. Some insurance plans treat a tele-visit like an equivalent to an office visit. If that’s the case, you could submit the receipt to them. Even if not, consider that many specialist co-pays in person might be $40-$50 or more, plus the transit costs. A telehealth fee might be comparable, and you save the peripheral expenses. Additionally, using an HSA or FSA account to pay can effectively be tax-advantaged spending for your healthcare.
• Availability of Specialists: Doctors365 has a broad network. For cardiology, you’ll find general cardiologists (who can manage a wide range of heart issues) as well as those with subspecialties like interventional cardiology, heart failure, electrophysiology, etc. The availability can vary – some doctors might only do a few hours in evenings, others might be almost full-time telehealth providers. The platform often ensures that across the roster, there’s availability around the clock. For instance, if you need help at 10 pm, perhaps a West Coast doctor who’s still working could take your call, whereas your local doctors might be offline. This network effect means you’re not limited to one geographic area’s schedule.
• International and Multilingual Options: If you happen to be traveling or living abroad, you might still access Doctors365 (checking any local telemedicine regulations). Also, some doctors might speak multiple languages, which can be comforting if English isn’t your first language. The profiles usually note languages spoken.
• Follow-up Appointments: Many doctors will have you follow up as needed. Sometimes a brief check-in might even be through messaging if offered (though official consults are via video for thoroughness). The cost of follow-ups might be lower if less time is needed. Doctors365 encourages fair pricing – it’s in the platform’s interest to keep patients happy with value. You’ll likely find it’s quite reasonable compared to the out-of-pocket cost of, say, an urgent care center or ER (which can be hundreds just to walk in, especially if you have a high deductible plan).
• No Subscription Required: Unlike some telehealth services that require a monthly membership, Doctors365 typically lets you pay per visit. This is great if you just need a one-time consult or occasional use. Of course, if you have multiple follow-ups, you just book them as needed. There might be packages if you prefer (some chronic disease management programs offer monthly fees for more continuous access), but that’s optional. The a la carte model is straightforward: pay for what you need, when you need it.

In summary, online heart consultations are accessible and flexible in cost. You have control over whom you see and what you pay, with no long-term commitments unless you choose. And the ability to get high-quality advice promptly can actually save you money by potentially avoiding costlier interventions or catching issues early.

Now, let’s ensure you’re set up for success when you do schedule that online appointment. The next section gives some practical tips to get the most out of your virtual doctor visit.

17. Tips for a Successful Online Cardiology Appointment

To make sure your online visit goes smoothly and you get the most out of it, consider the following tips:

• Test Your Tech: Before the appointment, check that your device (computer, tablet, or smartphone) is working well. Ensure your internet connection is stable. You might do a quick test call with a friend or use the platform’s test features if available. Use a device with a camera and microphone and grant the necessary permissions for the browser or app. If you’re not tech-savvy, ask a relative to help set it up beforehand.
• Prepare Your Information: Just like an in-person visit, it helps to have your medical information handy. Make a list of your medications (names and doses) to share with the doctor. Jot down key medical history points (prior surgeries, major diagnoses, allergies). If you have recent vital signs, note them: things like your blood pressure readings at home, heart rate, weight changes, etc. For heart failure patients, having a log of daily weights and symptoms is excellent information to provide. Also, keep any relevant medical reports or test results nearby. You may be able to upload these through the platform before or during the call. For example, if you had an echocardiogram done recently, having the report (or at least knowing the ejection fraction and major findings) will help the online doctor give more tailored advice.
• Note Your Symptoms Clearly: Because the doctor can’t examine you physically, your description of symptoms is crucial. Try to be specific: “For the past 2 weeks, I get breathless after walking 1 block, whereas before I could do 3 blocks. I wake up at night needing an extra pillow. I’ve also noticed my ankles swelling by evening.” This kind of detail helps paint a picture. If discussing palpitations, describe the sensation and timing: “It feels like rapid flutters for 10 seconds, a few times a day, and sometimes I feel lightheaded when it happens.” Writing these down beforehand ensures you won’t forget to mention them.
• Choose a Quiet, Well-Lit Space: During the video call, you want the doctor to hear you clearly and possibly see you well (especially if you need to show something like your neck veins or ankles). Sit in a quiet room, away from TV or noisy pets. Good lighting (in front of you, not just behind) will make your video clearer. If you’re on a phone, propping it up on a stand or table is better than holding it (to avoid shaky cam). Also, consider having a family member present if you feel you might need help remembering information or if they have observations to add (caregivers often have useful insights, e.g., “I noticed he’s more short of breath when climbing stairs than before”). Just be mindful of privacy – only involve others if you’re comfortable sharing your health info with them.
• Have Home Devices Ready: If you have a blood pressure monitor, pulse oximeter, or blood sugar meter at home, have them within reach. The doctor might ask, “What’s your blood pressure right now?” or “Can you check your oxygen level?” This can be very useful data. Similarly, if you have a list of recent blood pressures or glucose readings logged, those are great to share (perhaps as a chart or just verbally). If your pacemaker/ICD has a home monitoring unit, make sure it transmitted recently so that the doctor can get the latest info if they have access (they might need to coordinate with your device clinic for specifics, but having the concept of when it was last checked helps).
• Ask Questions and Take Notes: Don’t hesitate to ask the doctor to clarify anything you don’t understand. Sometimes in a video call, people feel they need to rush, but you generally have the provider’s full attention (no interruptions like in a clinic). Use that opportunity. If the doctor mentions a term like “ejection fraction” or “bundle branch”, and you’re not sure what it means, feel free to ask for an explanation. Most doctors on telehealth are very good at patient education – they may even draw a quick sketch on paper and hold it up, or use screen-share for a diagram. Have a notepad to jot down key points or instructions. Although you will get a written summary later, it’s good to note things in real-time in case you want to follow up on them during the same call.
• Follow Through on Next Steps: After the consult, if the doctor recommended seeing someone in person or getting tests, try to schedule those promptly. The convenience of the online visit can sometimes make us procrastinate on the harder stuff, but remember, those recommendations are to help you. If booking through Doctors365, you might even find in-person providers via their referral suggestions, or use the summary note as a referral to give your local provider. If the online doctor said, for example, “I think you should have an in-person evaluation for device implantation,” you can even use Doctors365 to find a cardiologist or EP near you for that procedure (or ask your primary doctor to refer). The idea is to integrate the telehealth advice into your real-world care continuum.

With these preparations, you’ll be set for a productive online session. Telemedicine might feel a bit different at first, but many patients quickly come to prefer it for its ease and the way it empowers them to be more involved (you often end up more informed about your health through these detailed discussions).

We’ve covered a lot of ground – from pacing therapies to telehealth logistics. Let’s wrap up with a summary and a call to action, encouraging you to take charge of your heart health with the resources available.

18. Conclusion: Embracing the Future of Pacing and Telemedicine

In this comprehensive guide, we’ve journeyed through the exciting world of advanced cardiac pacing and the modern conveniences of telemedicine. Conduction System Pacing (CSP) and Biventricular Pacing (CRT) represent the cutting edge of treating electrical problems in the heart, offering hope for better synchrony and improved heart function. While CRT has been a stalwart therapy improving many lives, CSP is emerging as a more physiologic alternative, showing promise with narrower QRS durations, potential for better symptom relief, and comparable (if not better) improvements in heart pumping efficiency. Current evidence indicates that CSP is safe and effective in diverse scenarios – from heart failure patients without LBBB to those with atrial fibrillation needing AV node ablation – often matching or exceeding the outcomes of traditional CRT [1][5][7]. As research continues, we may well see CSP becoming a standard option, personalized to patient needs.

On the patient side, it’s natural to wonder what these developments mean for you. The key takeaway is that you have options. If you or a loved one is facing the prospect of a pacemaker or CRT, it’s worth discussing conduction system pacing with your doctors. The best choice depends on individual factors, but being informed empowers you to ask the right questions. Are you a candidate for LBB pacing? Would His-bundle pacing address your particular conduction delay? Understanding these terms and the latest evidence (which we’ve cited from leading medical studies [1–5][7]) allows you to engage in a meaningful dialogue with your cardiologist.

Moreover, you don’t have to navigate these complex decisions alone or wait weeks for appointments. With platforms like Doctors365, you can quickly connect with cardiology specialists who are up-to-date on these advancements. Our service allows you to get expert advice, second opinions, and follow-up care without the friction of traditional healthcare logistics. Many of our doctors are passionate about patient education – they stay current with research (like the studies referenced in this article) and can translate what it means for your care. Whether it’s confirming that CRT is the right call for you or suggesting that CSP might be a viable alternative, an online consultation can bring clarity and peace of mind.

Telemedicine also means continuous support. Managing a heart condition is not a one-and-done; it’s a journey. But with online care, you have a lifeline. If you feel uncertain, if new symptoms develop, or if you just need reassurance, help is just a click away at any hour. This constant connectivity can improve adherence to treatments, catch issues early, and ultimately lead to better outcomes. It’s like having a team of doctors on standby for you – a comforting thought for anyone with a chronic condition.

In closing, the convergence of advanced medical therapies and telehealth services is truly a win-win for patients. You benefit from the best of medical innovation (like CSP for pacing) and the best of modern communication (like Doctors365 for care access). So why not take advantage of both? If you’re curious about whether conduction system pacing might be suitable for you, or if you simply want a top cardiologist to review your case, we invite you to reach out through our platform.

Your heart’s health is in your hands. Stay informed, ask questions, and use the tools available – both technological and medical – to ensure you get the care you deserve. The future of cardiology is here now, and you can be part of it by making empowered choices today.

Ready to take the next step? Book an online consultation with a heart specialist on Doctors365 (visit our cardiology specialists page to get started). It’s never been easier to get expert, personalized guidance for your heart health journey. Your heart will thank you for it!

Written by Diellza Rabushaj, Medical Writer & Researcher.

Frequently Asked Questions (FAQs)

Q: What is the difference between conduction system pacing and biventricular pacing?
A: Conduction system pacing (CSP) involves placing a pacemaker lead directly into the heart’s conduction fibers (like the His bundle or left bundle branch) to stimulate the heart’s own electrical network. Biventricular pacing (CRT) uses two leads, one in the right ventricle and one on the surface of the left ventricle, to make both ventricles beat together. CSP effectively “uses the heart’s original wiring,” often resulting in a more natural activation (narrower QRS on ECG), whereas BVP “adds new wires” to resynchronize the beat. Both aim to correct dyssynchrony, but they go about it differently.

Q: Is conduction system pacing better than traditional CRT for heart failure?
A: “Better” can depend on the patient, but evidence so far suggests CSP is at least as good as CRT for many patients – and possibly superior in certain ways. Studies have shown CSP achieves narrower QRS complexes and can improve left ventricular function as much or more than CRT in some cases [5][7]. Patients without left bundle branch block, for example, saw greater ejection fraction improvement with CSP than with CRT [5] Symptom-wise, patients have had similar or better improvement in functional class with CSP[3]. That said, large trials are still ongoing to compare long-term outcomes like survival. So CSP is very promising and may be better for specific groups, but CRT remains a proven therapy especially for classic LBBB patients.

Q: Who is a good candidate for conduction system pacing?
A: Candidates for CSP include people who need a pacemaker or CRT and have indications for maintaining synchrony. For instance, if you have heart failure with a wide QRS (especially non-LBBB patterns) or need pacing after AV node ablation for atrial fibrillation, CSP is a great option. Younger patients who need lifelong pacing for heart block also benefit to avoid pacing-induced dysfunction. Ultimately, candidacy depends on your heart’s anatomy and conduction – your cardiologist or electrophysiologist will consider if they can place a lead in the His bundle or left bundle area successfully. If there’s a lot of scar in those areas or other constraints, they might opt for traditional CRT. It’s worth asking your doctor about CSP if you’re told you need a pacemaker or CRT; they can evaluate your specific case.

Q: Are there any risks or downsides to conduction system pacing compared to normal pacemakers?
A: CSP carries similar risks to regular pacemaker implantation (like infection, bleeding, lead dislodgement), with a few unique considerations. It can be a bit more technically challenging to implant, so it’s important to have an experienced operator. There’s a small risk of causing block in the conduction system during placement, but that’s uncommon. His-bundle pacing can sometimes have higher capture thresholds (meaning the pacemaker uses more battery to stimulate the heart), but left bundle pacing usually has stable, low thresholds. Long-term data is still being collected, but so far CSP leads are performing well. They don’t seem to have higher failure rates and patients paced via CSP are doing well clinically in studies. One downside might be that not all centers offer it yet – availability of the technique could be a limiting factor for now.

Q: Can I discuss pacemaker or defibrillator options with a doctor online and actually get one through telemedicine?
A: You can certainly discuss your options with an online cardiologist – that’s a smart way to become informed about whether you need a device and which type might be best (CSP vs CRT vs a standard pacemaker or defibrillator). The online doctor can review your records, answer questions, and even help coordinate a plan. However, you cannot get a device implanted via telemedicine – the procedure has to be done in person at a hospital or clinic by a cardiology/electrophysiology team. What telemedicine can do is expedite the pathway: for example, a Doctors365 cardiologist could confirm you meet criteria for a defibrillator or CRT, then refer you to a local center for implantation. They can even help with the pre-op workup (like ordering labs or imaging needed before the procedure). Post-implant, they can follow up with you online to monitor your recovery and device function (with remote downloads). So while the actual implantation isn’t virtual, much of the surrounding care can be managed conveniently online.

References

1. Mavilakandy, A., Abdelrazik, A. M., Abouelmagd, K., Koev, I., Chotalia, R., Sudhakaran, S., Koya, A. I., Antoun, I., Eldeeb, H., Ahamed, H., Dhutia, H., Somani, R., Ng, G. A., & Ibrahim, M. (2025). A comparative analysis of conduction system pacing and biventricular pacing in patients undergoing atrioventricular node ablation: A systematic review and meta-analysis. Europace, 27(7), euaf106. https://doi.org/10.1093/europace/euaf106
2. Pung, X., Chua, J. J. L., Fong, K. Y., Chua, Y. Y., Loo, G. J. M., Ong, J. W. S., Tay, J. C. K., Teo, H. K., Wang, Y., Yeo, C., Lim, E. T. S., Ho, K. L., Chong, D. T. T., Ching, C. K., & Tan, V. H. (2025). Conduction system pacing versus biventricular cardiac resynchronization pacing: Meta-analysis on outcomes in patients with non-left bundle branch block. Medicina, 61(7), 1240. https://doi.org/10.3390/medicina61071240
3. Paluszkiewicz, P., Martuszewski, A., Smereka, J., & Gajek, J. (2025). A meta-analysis of clinical and echocardiographic outcomes of physiological versus conventional pacing. Biomedicines, 13(6), 1359. https://doi.org/10.3390/biomedicines13061359
4. Yeshwant, S., & Upadhyay, G. A. (2025). The evolution of conduction system pacing and gaps in understanding. Progress in Cardiovascular Diseases, 91, 113–120. https://doi.org/10.1016/j.pcad.2025.06.006
5. Felix, I. F., Collini, M., Fonseca, R., Guida, C., Armaganijan, L., Healey, J. S., & Carvalho, G. (2024). Conduction system pacing versus biventricular pacing in heart failure with reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm, 21(6), 881–889. https://doi.org/10.1016/j.hrthm.2024.02.035
6. Bertini, M., Canovi, L., Vitali, F., Marcantoni, L., Pastore, G., Volpicelli, M., Munciguerra, O., Biffi, M., Ziacchi, M., Rossi, L., Carinci, V., Sirugo, P., Pastori, P., Imberti, J. F., Pellegrino, P. L., Guerriero, E., Sassone, B., Bertagnin, E., Coppola, G., … Zuin, M. (2025). Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: A registry-based trial. Europace, 27(8), euaf181. https://doi.org/10.1093/europace/euaf181
7. Pung, X., Chua, J. J. L., Fong, K. Y., Chua, Y. Y., Loo, G. J. M., Ong, J. W. S., Tay, J. C. K., Teo, H. K., Wang, Y., Yeo, C., Lim, E. T. S., Ho, K. L., Chong, D. T. T., Ching, C. K., & Tan, V. H. (2025). Conduction system pacing versus biventricular cardiac resynchronization pacing: Meta-analysis on outcomes in patients with non-left bundle branch block. Medicina, 61(7), 1240. https://doi.org/10.3390/medicina61071240
   
   Author: Dr. Diellza Rabushaj
   Medically reviewed by: Dr. Spec Orhan Karahodza