Conclusion
BiV pacing has shown to improve symptoms and reduce hospitalizations and
mortality in large randomized controlled trials and remains the standard
of care for patients with HF and significant electrical dysynchrony. New
modalities such as HBP and LVSP has shown to be equal or superior to BiV
pacing in regards to the surrogate measures such as improvement in
hemodynamics as well as with LV remodeling. There are no large clinical
trials comparing BiV pacing with other pacing modalities such as HBP and
LVSP for hard efficacy endpoints such as hospitalization and mortality
and are unlikely to be performed in the future. Currently, HBP and LVSP
has an important role to play in patients who are unable to receive BiV
pacing for one reason or the other. Future of HBP and LVSP looks
promising and only time will tell if it will replace the conventional
BiV pacing.