What are the long‑term clinical outcomes, including rates of heart‑failure hospitalization and all‑cause mortality, for patients with a unicameral leadless pacemaker (LP) who receive conduction‑system pacing (CSP) compared with those who receive a bicameral LP?
A unicameral LP (left‑ventricular pacing only) differs from a bicameral LP, which paces both ventricles. Conduction‑System Pacing (CSP) is a newer technique that seeks to restore the heart’s native activation sequence by directly stimulating the His–Purkinje system or left bundle branch.
Current evidence—principally a systematic review and meta‑analysis comparing CSP with traditional biventricular pacing (a form of bicameral LP used for cardiac resynchronization therapy)—suggests that CSP confers meaningful long‑term advantages:
These data indicate that, for patients upgraded from a unicameral LP, replacing it with CSP may lower both mortality and heart‑failure admissions compared with replacing it with a bicameral LP.
However, the median follow‑up in the meta‑analysis was only about 10 months. Robust confirmation will require larger randomized trials with multi‑year follow‑up across diverse patient subsets and device platforms.
Conclusion: Initial research favors CSP over bicameral leadless pacing for better long‑term outcomes, but ongoing studies with longer observation periods are needed to validate and refine these findings.