Vienna, 30 March 2025– The European Society of Cardiology (ESC) has released a groundbreaking consensus statement on conduction system pacing (CSP), marking a significant milestone in the evolution of pacing therapy. The document was officially presented today at the EHRA 2025 congress in Vienna and simultaneously published in EP Europace.
For over 50 years, right ventricular pacing has been a standard treatment for slow heart rhythms. However, in some patients, this approach can lead to reduced heart function and even heart failure. Furthermore, biventricular pacing has emerged over the past two decades as an effective therapy for select heart failure patients. Yet it does not always yield the desired clinical response and has certain limitations.
In the search for alternative pacing strategies, conduction system pacing—stimulation of the heart’s natural electrical conduction pathways—has gained increasing attention. His bundle pacing (HBP) was first recognised for use in selected patients in the 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. More recently, left bundle branch area pacing is being increasingly adopted due to its perceived ease of implantation and superior electrical performance.
ESC Clinical Consensus Statement offers updated guidance to healthcare professionals on selecting patients for conduction system pacing. Developed by leading international experts in pacing therapy and in heart failure, the document is endorsed by major Sister Societies worldwide, including the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society (United States), and the Latin American Heart Rhythm Society. Notably, the patient perspective has also been incorporated to ensure a comprehensive and patient-centered approach. Scientific evidence has been rigorously reviewed, and the document presents advice in a clear, structured format.
Professor Haran Burri, Co-chair of the ESC Clinical Consensus Statement and EHRA President-Elect: “While this consensus document marks a pivotal step forward in pacing therapy, we eagerly await further insights from ongoing randomised controlled trials that will refine patient selection criteria in the coming years.”
Professor Michael Glikson, Co-chair of the ESC Clinical Consensus Statement and the 2021 ESC Guidelines: “Conduction system pacing is a big step forward in the pacing world. Since the publication of our ESC guidelines in 2021, there have been thousands of publications on CSP, and we are already seeing a significant paradigm shift in the real-world application of pacing. This is why this document is so timely. We hope to see further progress in this area of pacing in the years to come."
ENDS
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References and notes:
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ESC Clinical Consensus Statement on Conduction System Pacing. With special contribution of the European Heart Rhythm Association (EHRA) of the ESC and endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Canadian Heart Rhythm Society (CHRS), the Heart Rhythm Society (HRS) and the Latin American Heart Rhythm Society (LAHRS), EP Europace 2025
Available here at publication
About the European Heart Rhythm Association
The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve patients’ quality of life and reduce sudden cardiac death by limiting the impact of heart rhythm disturbances.
EHRA 2025 will be held from 30 March to 1 April in Vienna, Austria, and online. Explore the Scientific Programme.
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About the European Society of Cardiology
The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.
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