Optimal choice of cardiac resynchronization therapy for chronic heart failure — left bundle branch pacing

As a common cardiovascular disease, chronic heart failure is mainly caused by cardiac electromechanical dyssynchrony. Cardiac resynchronization therapy (CRT) is an effective treatment of intractable chronic heart failure with ventricular asynchronous manner. Traditional biventricular pacing can correct electro-mechanical dissynchronization, reverse cardiac remodeling, improve clinical symptoms and significantly reduce the re-hosptialization rate and mortality in patients with chronic heart failure. However, it is not a true physiologic synchronous pacing and nearly 30% of patients fail to benefit from it. In recent years, His bundle pacing (HBP) and left bundle branch pacing (LBBP), as the representative of physiologic pacing, have shown great effect in CRT. LBBP, in particular, is not only effective for chronic heart failure but also can achieve narrower QRS wave, lower threshold and more stable output. This paper reviews the application status and prospect of LBBP in the prevention and treatment of chronic heart failure.