Patient-specific Visualisation of the Cardiac Conduction System to Guide Structural Interventions and Physiological Pacing

The cardiac conduction system is frequently injured during structural heart disease procedures and it remains difficult to target accurately during conduction system pacing. These current approaches both lead to increased mortality and morbidity. The authors review the anatomical basis, estimated conduction system calibration and subsequent clinical application of a novel CT angiography-based conduction system visualisation platform that enables patient-specific 3D estimation and mapping of the atrioventricular conduction axis for real-time procedural guidance. This breakthrough technology enables clinicians to avoid iatrogenic damage by implanting devices with respect to patient-specific conduction anatomy and to achieve true physiological pacing by targeting precise locations along the conduction system. The authors have applied this visualisation system in more than 2,000 patients undergoing structural heart disease and conduction system pacing procedures, and the results of this early experience are reviewed here. Conduction system-guided intervention provides a framework for a potential shift in cardiac care, with planned prospective trials to further validate these promising outcomes.