The European Society of Cardiology (ESC) has unveiled a transformative consensus statement concerning conduction system pacing (CSP), heralding a new era in the treatment of heart rhythm disorders. This milestone document was disclosed at the EHRA 2025 congress in Vienna and concurrently published in EP Europace, addressing the limitations of traditional right ventricular pacing and offering alternative solutions.

For decades, right ventricular pacing served as the standard for managing slow heart rhythms. Nevertheless, this method occasionally leads to diminished cardiac function or even heart failure in some patients. Over the past two decades, biventricular pacing emerged as an effective therapy for certain heart failure cases but has not always provided the desired outcomes due to inherent constraints. In response to these challenges, CSP—stimulating the heart's natural electrical pathways—has garnered increasing attention. His bundle pacing (HBP) was initially acknowledged for specific patient groups in the 2021 ESC guidelines, while left bundle branch area pacing is now gaining traction due to its ease of implantation and superior electrical performance.

This consensus statement provides updated guidance for healthcare providers regarding patient selection for CSP. Developed by leading international experts in pacing therapy and heart failure management, it is endorsed by major global societies, including those from Asia Pacific, Canada, the United States, and Latin America. Importantly, the patient perspective has been integrated to ensure a holistic, patient-centered approach. The document meticulously reviews scientific evidence and presents recommendations in an accessible format.

According to Professor Haran Burri, co-chair of the consensus statement, this document represents a crucial advancement in pacing therapy. However, further insights from ongoing randomized controlled trials are anticipated to refine patient selection criteria over the next few years. Professor Michael Glikson, another co-chair, emphasizes that CSP marks a significant leap forward in the pacing field. Since the publication of the ESC guidelines in 2021, thousands of studies have been conducted on CSP, indicating a substantial shift in real-world applications.

As the medical community embraces this innovative approach, the future of pacing therapy appears promising. With continued research and advancements, the coming years may witness further evolution in this domain, enhancing patient care and outcomes worldwide.