Hackensack University Medical Center Participates in International Panel of Experts Drafting New Heart Pacing Guidelines

Published:
June 28, 2023

What You Need To Know

  • Hackensack University Medical Center was a member of a large panel of experts from around the world who drafted new guidelines for the use of conduction system pacing to prevent or reduce heart failure in adults and children with heart rhythm abnormalities.
  • Taya V. Glotzer, M.D., an electrophysiologist and director of Cardiac Research at Hackensack University Medical Center and professor of medicine at Hackensack Meridian School of Medicine, was one of the authors. The findings were published in the journal Heart Rhythm in May 2023.  

New Conduction System Pacing

In the early 2000s, researchers began developing ways to pace the heart's own conduction system, which naturally activates the right and left sides simultaneously. The native conduction system begins at one point at the top of the heart and goes down specialized conduction tissue to the right and left sides.  New conduction system pacing involves the insertion of a single lead into the heart’s native conduction fibers. By anchoring the lead in the right side of the septum and advancing the wire to the left side of the heart, the pacemaker can stimulate the heart's natural conduction system.  Technically the procedure may prove to be easier than biventricular pacing, and tools are currently only in their infancy. Conduction system pacing is now an alternative to biventricular pacing in patients with heart failure, bundle branch blocks, weakened heart muscles, and those who require pacing at least 20%-40% of the time. One type of conduction system pacing targeting this bundle was approved by the FDA in 2018. A second type of conduction system pacing, left bundle branch area pacing, was FDA approved in 2022.

Conduction System Pacing Guidelines

The new conduction system pacing guidelines were released by the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, and Latin American Heart Rhythm Society. The authors emphasize the importance of shared decision-making between providers and patients when considering treatment with a conduction system pacing device. They note that these discussions should account for a patient's values, preferences, and care goals while considering the potential advantages and risks associated with pacing therapy. In addition, the authors acknowledge that critical gaps remain in our current understanding in the field and highlight novel directions for future research. Hackensack University Medical Center is doing its own study on the long-term effects of conduction system pacing, led by Dr. Glotzer. The hospital is also participating in a major prospective randomized clinical trial as one of several sites in the United States and Canada comparing conduction system pacing to biventricular pacing in patients who have bundle branch blocks and weak heart muscles, with Dr. Glotzer as the site's primary investigator. The study will begin enrolling patients next year.