Date of Award

Spring 2026

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

First Advisor

Julie Solberg

Keywords

Conduction system pacing, Left Bundle Branch Area Pacing, Heart Failure with Reduced Ejection Fraction, Left Ventricular Ejection Fraction, Paced QRS Duration, NYHA Symptoms

Abstract

Cardiac Resynchronization Therapy (CRT) is used in patients diagnosed with heart failure with reduced ejection fraction. CRT is used to artificially pace both ventricles with the intent of one synchronous contraction of the right and left ventricle. The synchrony of contraction aims to increase left ventricular ejection fraction to alleviate heart failure symptoms and morbidities. Traditional bi-ventricular pacing utilizes lead placement in the coronary sinus to pace and electrically capture the posterior myocardium of the left ventricle. Current trends in research reveal the emergence of a novel pacing technique of pacing leads implanted into the septum of the right ventricle with the intent of electrical capture of the heart’s natural conduction system leading to resynchronization of the right and left ventricles. The purpose of this literature review is to examine the effectiveness of a novel pacing technique for CRT. The electronic databases Pubmed and EMBASE were searched; five studies were chosen for review comparing traditional bi-ventricular pacing to the novel conduction system pacing. Conduction system pacing encompassed both techniques of his-bundle pacing and left bundle branch pacing. Current findings from research suggest that the novel conduction system pacing leads in greater improvements in LVEF, narrower paced QRS complex, and further reduction of NYHA classification of heart failure symptoms when compared to traditional Bi-ventricular pacing with a coronary sinus lead. Future research should focus on large cohort randomized control trials comparing the two pacing techniques.

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