8. Looking to the Future
The great interest in CSP in recent years logically directs towards the
issues that make difficulties so that this type of pacing prevails as
the dominant one for all prospective patients who may need this type of
intervention.15 Given the complicated anatomy of the
area where the conduction system locates, new tools are tested by all
manufacturers, both for HBP and LBBP. The tests concern the sheaths that
guide the pacing lead and the lead model itself. Stylet-driven leads,
tested in the past, are already being tested again to locate the area of
interest with greater precision and stability, bypassing the existing
anatomical and hemodynamic difficulties.68 Moreover,
efforts to circumvent the difficulties of locating the conduction system
with fluoroscopy are being made by testing new 3D electro-anatomical
mapping systems.69 Recently published data is also
encouraging for an electrogram-only guided approach to HBP with minimal
fluoroscopy and high success rates compared to the classical
method.70 But of course, the need for data collection
through conducting large RCTs, which will prove the significant benefit
of this pacing in clinical endpoints of hospitalizations and mortality,
should not be overlooked. For this reason, studies are constantly
conducted in this direction. Thus, for the question concerning CSP
“when and to whom”, the answer one day may be “always and to all”.