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”.