Boston Medical Center – Brighton
Direct Left Bundle Pacing
The electrophysiology team at BMC Brighton was among the first in New England to implement direct conduction system pacing, also known as direct left bundle pacing.
Why Is Left Bundle Pacing Used?
Ineffective contraction of the heart, or dyssynchrony, in the lower chambers may result over time from a standard pacemaker procedure or from underlying problems in the electrical conduction system of the heart.
The reasons for dyssynchrony include abnormal conduction of the electrical signals in the heart or, in the case of artificial pacemakers, stimulation in the areas far away from the natural conduction pathways.
The His bundle and its continuation, the left bundle branch, are parts of this natural conduction system. Placement of a pacing lead directly into the His bundle was first described in 1968 by a pioneer of pacing, Dr. Bernard Kosowsky, who was also the founder of cardiology services at BMC Brighton. This method has been gaining popularity over the last decade.
The latest expansion of this method involves direct placement of the pacing lead just below the His bundle, into a more distal conduction system or the left bundle branch. This procedure may be technically easier to achieve than His bundle pacing, and may allow for broader application of physiologic pacing to avoid cardiac dyssynchrony.