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Physiological Pacing

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Understanding Physiological Pacing / Conduction System Pacing

Physiological Pacing, also known as Conduction System Pacing, is a breakthrough approach in treating patients afflicted with complete heart block. This innovative method significantly mitigates the risk of pacing-induced cardiomyopathy and heart failure by employing a more natural mode of stimulating heartbeats, thus maintaining the equilibrium in cardiac function.

It works by engaging with the heart's inherent conduction system, thereby preventing the ventricular dyssynchrony and cardiac dysfunction commonly seen with traditional pacing methods.

The latest advancement in this field is the HIS Bundle Pacing and Left Bundle Branch Pacing, a state-of-the-art alternative to Right Ventricular (RV) Pacing. With this novel technique, we can leverage the heart's normal electrical conduction system to deliver a pacing solution that reduces the risk of cardiac function deterioration. This unique approach exemplifies a physiological way of pacing the heart, giving patients a safer, more effective treatment option.

Under the guidance of our esteemed expert, Dr Karthigesan, you can trust us to deliver care that aligns with your body's natural rhythm. Experience the future of cardiac care today at Dr Karthigesan Clinic.

The image illustrates the heart's Conduction System Pacing with graphs.
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Evaluating Physiological Pacing / Conduction System Pacing

Dr. Karthigesan may recommend several diagnostic tests to identify the reasons for your abnormal heartbeat before deciding on pacemaker implantation. The tests include:

  • Holter monitor test
  • Cardiac event monitor
  • External Loop recorder
  • Electrocardiogram
  • Stress test
  • Echocardiogram
The image illustrates the Physiological Pacing.
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Procedure Overview: Physiological Pacing / Conduction System Pacing

Physiological Pacing, also known as Conduction System Pacing (CSP), is an innovative cardiac pacing technique that employs the heart's own conduction system, allowing for effective and physiological ventricular activation.

  • RVP and BVP are the traditional pacing methods. In RVP, the lead placement inherently introduces inter-ventricular dyssynchrony.
  • CSP, through careful placement of the lead in the His-bundle or the Left Bundle Area (LBA), presents a refined alternative that addresses inter-ventricular and intra-ventricular dyssynchrony through physiological activation.
  • This procedure is performed under local anaesthetic with sedative medication to ensure your comfort.
  • The pacemaker is carefully inserted just under the collarbone at the front of the chest, typically on the left side.
  • Special tools and electrophysiology(EP) systems are utilised to place the lead into the conduction system, a procedure that demands technical finesse.
  • Post-placement, the engagement of the conduction system is confirmed by diligently monitoring a 12-lead ECG during pacing.

The Benefits of: Conduction System Pacing

  • HIS Bundle or Conduction System Pacing ensures enhanced cardiac contraction. This directly translates into a noticeable improvement in your quality of life, greater walking distance, and a significant reduction in breathlessness compared to traditional Right Ventricular (RV) Pacing.
  • This technique enables synchronised ventricular contraction by harnessing intrinsic activation patterns. This effectively tackles the dyssynchrony associated with RV pacing, often leading to a higher ejection fraction than conventional pacing.
  • Physiological Pacing reduces the likelihood of right ventricular pacing-induced cardiomyopathy in comparison to conventional pacing, thereby offering an added layer of protection to your heart health.
  • For patients in whom left ventricular lead implantation has failed, Physiological Pacing offers an alternative, viable implant site.
  • Especially beneficial for patients with heart failure, this method has been observed to cause a rise in blood pressure indicating haemodynamic improvement when compared to biventricular pacing or in addition to biventricular pacing.
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It's time to navigate towards unparalleled heart health. With Dr Karthigesan's expertise in Physiological Pacing, expect more than just treatment - experience transformation.

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Physiological Pacing - Your Queries Answered

While traditional pacemakers restore normal heart rhythms for millions globally, the prevalent technique involving the ventricular lead placement in the lower Right Ventricle carries its own challenges. This approach can elevate the risk of complications such as atrial fibrillation and heart failure and potentially increase mortality rates.

The heart’s conduction system is an intricate network of nodes, specialised cells, and electrical impulses that orchestrate the rhythm of your heartbeat. It includes two primary types of cells:

  • Conducting cells:  These cells transport electrical signals.
  • Muscle cells:  These cells regulate your heart’s contractions.

Your cardiac conduction system is responsible for initiating the heartbeat and signalling different parts of your heart to contract and relax. This coordinated dance of contraction and relaxation governs the blood flow through your heart and, subsequently, the rest of your body.

The cardiac conduction system encompasses specialised cells and nodes that fine-tune your heartbeat. These include the:

  • Sinoatrial Node
  • Bundle of His (Atrioventricular Bundle)
  • Atrioventricular Node
  • Purkinje Fibers

Many heart rhythm disorders stem from genetic factors and may be influenced by your heart’s structure or other factors. Nevertheless, you can proactively maintain a healthy cardiac conduction system and overall heart health by adopting a wholesome lifestyle. Recommended measures include:

  • Achieving and maintaining an optimal weight.
  • Abstaining from smoking.
  • Avoiding misuse of drugs or prescription medications.
  • Limiting alcohol consumption.
  • Consuming a balanced diet rich in fruits, vegetables, and whole grains.
  • Engaging in at least 150 minutes of aerobic exercise per week.
  • Effectively managing stress through healthy coping techniques like meditation or talk therapy.

Conduction System Pacing (CSP), while advantageous, does pose certain challenges. The technique's overall complexity requires additional training for cardiac physiologists, and the wider catheter lab team, not only during the implant procedure but also for follow-up and device programming. Additionally, current devices lack CSP-specific algorithms and auto-adjustments, as seen in conventional pacing.

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