Estimulación fisiológica: estado actual y perspectivas futuras

Conduction system pacing is a cardiac pacing modality that seeks to maintain ventricular electromechanical activation synchrony through direct stimulation of the specific conduction system, generally the bundle of His or the left bundle branch. Although technically more complex than conventional right ventricular pacing, the advent of dedicated tools has favored its implementation in clinical practice as a more physiologic alternative to conventional right ventricular pacing and as a rescue strategy when conventional resynchronization therapy through biventricular pacing is not feasible. More recently, the growing scientific evidence that compares it to the latter would place it as a real alternative strategy in patients with heart failure and an indication for resynchronization. This text reviews the fundamentals of the main implant modalities and technique, the available scientific evidence, and future prospects.