In silico experiments explain the non-consistent benefit of conduction system pacing over cardiac resynchronization therapy. The need to personalize therapy.

The study by Strocchi et al. adds evidence that choosing the cardiac resynchronization therapy (CRT) according to the cardiac substrate of each patient could be beneficial. Perhaps the most appropriate approach in CRT would be to find the appropriate niche for each pacing method. It may be less about demonstrating the superiority of conduction system pacing (CSP) and more about personalizing the therapy for each particular patient. That is, a patient with septal scarring or diffuse conduction system disease could benefit more from biventricular CRT. On the other hand, someone with lateral myocardial scar or localized pathology (focal or proximal disease) within the conduction system would benefit more from CSP. In this context, ECGI could eventually play a main role in selecting the best therapy for each patient. This article is protected by copyright. All rights reserved.