Future Directions in Conduction System Pacing to Achieve Cardiac Resynchronization, Volume II

Normal cardiac performance depends on coordinated atrial, atrioventricular and ventricular activation. Conventional right ventricular myocardial pacing can produce non-physiological ventricular activation and may contribute to pacing-induced cardiomyopathy, heart failure and atrial arrhythmias. Biventricular pacing remains the established method of cardiac resynchronization therapy (CRT) for selected patients with heart failure and electrical dyssynchrony, but anatomical constraints and variable response limit its effectiveness. Conduction system pacing (CSP), through His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), seeks to preserve or restore physiological ventricular activation. Hybrid, endocardial and leadless approaches are now further expanding the available strategies. These developments create opportunities to individualize therapy across the pacing pathway.GoalSince the first edition of this Research Topic (Future Directions in Conduction System Pacing to Achieve Cardiac Resynchronization), physiological pacing has progressed from early feasibility studies towards comparative clinical trials, new lead and delivery technologies, and broader therapeutic applications. Resynchronization should increasingly be considered not only as narrowing the QRS or coordinating ventricular contraction, but as restoring atrial, atrioventricular and ventricular timing and an appropriate haemodynamic response. Important questions remain regarding patient and pacing-site selection; the relative roles of CSP, biventricular pacing and combined approaches such as His-optimized CRT (HOT-CRT) and left bundle branch-optimized CRT (LOT-CRT); and the potential use of physiological pacing in heart failure with preserved ejection fraction (HFpEF), prolonged atrioventricular conduction, hypertension and other emerging indications. Durable benefit also depends on programming, remote surveillance, system reliability and lifetime lead management.Scope and information for authorsThis Research Topic will examine mechanisms, technologies and clinical applications that may advance physiological pacing and resynchronization. We welcome Original Research, Methods, Systematic Reviews, Reviews, Mini Reviews and Perspectives addressing:- mechanisms and measurement of atrial, atrioventricular and ventricular dyssynchrony;- physiological atrial pacing and atrial resynchronization, including Bachmann bundle pacing;- selection and optimization of CSP, biventricular pacing, HOT-CRT and LOT-CRT;- pacing in HFpEF, prolonged PR interval and other emerging indications, including pacing-based haemodynamic or neuromodulatory therapy for hypertension;- leadless pacing, leadless left ventricular endocardial CRT and fully leadless systems;- remote monitoring of CSP and CRT, including capture assessment, programming, optimization and heart-failure surveillance;- long-term performance and lifetime management of transvenous and leadless systems, including extraction or retrieval, reimplantation and end-of-service strategy;- scar, arrhythmogenicity, difficult anatomy, and paediatric or congenital applications.Topic Editor Prof. Aldo Rinaldi has received research funding and honoraria from Abbott, Medtronic, and Philips. Topic Editor Prof. Steven Niederer has received research and operational funding from GSK and Ansys, and travel/meeting support from Johnson & Johnson, and serves on the advisory board for Lir Therapeutics. Topic Editor Dr. Vishal Mehta declares no competing interests with regard to the Research Topic subject. Topic editors: Christopher Aldo Rinaldi, Steven Alexander Niederer, Vishal Mehta Source: https://www.frontiersin.org/research-topics/78342/future-directions-in-conduction-system-pacing-to-achieve-cardiac-resynchronization-volume-ii