The risks and benefits of transseptal endocardial pacing

Purpose of review Transseptal endocardial left-ventricular pacing has a number of potential advantages over left-ventricular epicardial pacing from the coronary sinus, for implantation of cardiac resynchronization therapy (CRT) devices. In this study we review the risks and potential benefits. Recent findings Permanent transseptal endocardial pacing has been shown to be clinically feasible. Different methods have been described, including a superior, inferior or mixed approach. Endocardial pacing has a number of potential advantages over conventional left-ventricular pacing from the coronary sinus. It may be possible to achieve more effective CRT through optimizing the left-ventricular lead position, which is possible because of the greater choice of stimulation site. Endocardial rather than epicardial stimulation may result in more rapid ventricular activation and may be less arrhythmogenic. Disadvantages of this approach include the risk of thromboembolism and the potential for interaction with the mitral valve. Summary Transseptal endocardial left-ventricular pacing shows promise for use in cardiac resynchronization therapy. The safety and effectiveness of this technique should now be tested in larger clinical trials.