This Week in Cardiology Aug 22 2025 This Week in Cardiology
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Aug 22, 2025 John Mandrola delves into the differences between conduction system pacing and standard pacing, backed by recent trial findings. The discussion includes the implications of adjusting heart failure medications once atrial fibrillation is resolved. Insights from patient outcome data reveal concerning mortality rates in left atrial appendage occlusion procedures, emphasizing the necessity for improved patient selection, particularly among frail individuals. Anticipation builds for upcoming hypertension guidelines and studies at the Madrid ESC conference.
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Physiologic Activation Reduces Dyssynchrony
- Conduction system pacing (CSP) activates the heart via the His-Purkinje system, avoiding dyssynchrony from RV pacing.
- CSP may prevent pacing-induced cardiomyopathy by enabling near-physiologic bi-ventricular activation.
Nine Years Of CSP Practice
- John Mandrola shares his nine years of experience transitioning from His-bundle to left bundle pacing.
- He emphasizes CSP allows simultaneous ventricular activation and improved synchrony.
Train Carefully Before Offering CSP
- Expect conduction system pacing to be technically harder and require practice to interpret electrograms.
- Learn CSP techniques gradually and monitor for septal perforation and higher lead-revision rates.