Is it better to make the choice of transvenous conduction system pacing (CSP) when the unicameral device doesn’t work?
It depends. Bicameral LPs avoid leads and pockets, which is safer for elderly or infection-prone patients. CSP offers more physiologic pacing and long-term flexibility, especially in younger patients with high pacing burden or potential CRT/ICD needs. The choice is individualized based on infection risk, venous access, age, pacing needs, and future device planning.