The electrophysiology team at St. Elizabeth’s was among the first in New England to implement direct conduction system pacing also known as direct left bundle pacing.
Why is Left Bundle Pacing Used?
Ineffective contraction of the heart, also known as dyssynchrony, in the lower chambers may result over time from a standard pacemaker procedure or underlying problems in the electrical conduction system of the heart. The reasons for dyssynchrony include abnormal conduction of the electrical signals in the heart or in the case of artificial pacemakers – stimulation in the areas far away from the natural conduction pathways. His bundle and its continuation – left bundle branch – are parts of this natural conduction system. Placement of a pacing lead directly into the His bundle was first described in 1968 by a pioneer of pacing, who was also the founder of cardiology services at St. Elizabeth’s – the late Dr. Bernard Kosowsky. This method has been gaining popularity over the last decade.
The latest expansion of this method involves direct placement of the pacing lead just below the His bundle into a more distal conduction system or the left bundle branch. This procedure may be technically easier to achieve than His bundle pacing and may allow for broader application of physiologic pacing to avoid cardiac dyssynchrony.