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.