Long-Term Outcomes and Safety of His-Purkinje Conduction System Pacing in China: The ChiCSP Study (JCEP June 2026)-Article: Long-Term Outcomes and Safety of His-Purkinje Conduction System Pacing in China: The ChiCSP Study

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The ChiCSP study was a large, prospective registry from five Chinese centers that evaluated long-term safety, lead performance, and clinical outcomes of conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). A total of 3,336 patients were enrolled between 2019 and 2021; 3,167 received successful CSP, with mean follow-up of 41.3 months.<br /><br />The study used strict criteria to classify LBBAP into three subtypes: left bundle branch pacing (LBBP), unclassified LBBAP, and left ventricular septal pacing (LVSP). Most LBBAP cases were true LBBP (84.2%), while 12.5% were unclassified and 3.3% were LVSP.<br /><br />Overall, CSP showed good long-term safety and stable pacing performance. HBP had a slightly higher rate of significant threshold rise than LBBAP (5.03% vs 1.80%), but procedural complication rates excluding threshold rise were low and similar in both groups (about 1.3%). Lead dislodgement, perforation, infection, and other serious complications were uncommon.<br /><br />Clinical outcomes were best when true conduction system capture was achieved. In patients with left bundle branch block and heart failure with reduced ejection fraction, both HBP and LBBP produced the largest improvements in left ventricular ejection fraction (about 21%), whereas LVSP had the smallest improvement (12.1%) and was associated with a higher risk of death or heart failure hospitalization. In contrast, among patients paced for atrioventricular block, outcomes were generally similar across LBBAP subtypes.<br /><br />The authors conclude that CSP is a durable and safe pacing strategy, but accurate confirmation of left bundle capture matters. They propose a practical LBBAP classification to improve clinical interpretation, emphasizing that LBBP—not LVSP—drives the best outcomes, especially in resynchronization therapy.

Meta Tag

Concept His-Purkinje Conduction System Pacing

Concept Left Bundle Branch Pacing

Concept Left Bundle Branch Capture

Concept His Bundle Pacing

Concept Left Bundle Branch Area Pacing

Keywords

ChiCSP study

conduction system pacing

His bundle pacing

left bundle branch area pacing

LBBP

LVSP

lead performance

long-term safety

heart failure

left ventricular ejection fraction

His-Purkinje Conduction System Pacing

Left Bundle Branch Pacing

Left Bundle Branch Capture

His Bundle Pacing

Left Bundle Branch Area Pacing