Emerging treatments
Alternative pacing systems
Leadless pacemakers are a useful alternative to conventional pacing systems for single-chamber right ventricular pacing. These devices are useful in patients who have an indication for single-chamber pacing (e.g., patients with persistent atrial fibrillation with slow ventricular response or pauses) in whom there is a low anticipated pacing burden and there is no clinical need to ensure atrio-ventricular synchrony during pacing.[41] However, recent advances in leadless pacemakers now allow for atrial synchronous ventricular pacing with a single device or atrioventricular sequential pacing with a right atrial leadless device and a right ventricular leadless device that can work together.[71] Conduction system pacing, is an evolving form of permanent pacing that is being utilised in many clinical situations in which expected pacing burden is high and avoidance of the adverse effects of chronic right ventricular pacing is preferred. However, emerging data point to use of left bundle branch area pacing (LBBAP) as being of similar benefit, easier to implant and with better and lower long-term pacing thresholds.[71][72] More clinical studies are needed to identify which subgroups of patients with bradycardia would benefit the most from these technologies.
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