Cardiac Electrophysiology · Expert Spotlight
Dr. Parikshit S. Sharma, MD — Key Publications in Conduction System Pacing
A curated review of 16 landmark publications by one of the world's leading pioneers in His bundle pacing and left bundle branch area pacing — now Section Head of Electrophysiology at Cleveland Clinic Florida.
Parikshit S. Sharma, MD, MPH, FACC, FHRS
Section Head of Electrophysiology · Heart, Vascular & Thoracic Institute
Cleveland Clinic Florida, Weston, FL
Cleveland Clinic Florida, Weston, FL
Parikshit S. Sharma, MD, MPH, FACC, FHRS has emerged as one of the most prolific and influential voices in conduction system pacing (CSP) — a field that has transformed how cardiologists and electrophysiologists approach permanent pacing. His body of work spans foundational reviews, large multicenter registries, and international collaborative studies that collectively redefined the clinical standard for physiological pacing.
Having served as Section Chief of Cardiac Electrophysiology at Rush University Medical Center in Chicago for nearly a decade, Dr. Sharma joined Cleveland Clinic Florida in early 2025 as Section Head of Electrophysiology, where he continues his research focus on CSP, complex arrhythmia management, and the development of Florida's first EP fellowship program. Below is a curated summary of 16 of his most clinically significant peer-reviewed publications, organized by research theme.
16+
Featured publications reviewed
50+
PubMed-indexed papers
5
Research themes covered
His bundle pacing — foundational
1
Permanent His bundle pacing: shaping the future of physiological ventricular pacing
Sharma PS, Vijayaraman P, Ellenbogen KA · Nature Reviews Cardiology, 2019
Landmark review establishing the scientific rationale and clinical applications for His bundle pacing as a physiological alternative to right ventricular pacing. Covers His bundle anatomy, pacing mechanisms, correction of bundle branch block, and future directions. Considered a defining reference in the field.
2
Permanent His bundle pacing: the past, present, and future
Sharma PS, Ellenbogen KA, Trohman RG · Journal of Cardiovascular Electrophysiology, 2017
Comprehensive early review of HBP, including anatomy, implantation technique, available data on outcomes, and potential applications including CRT. Positioned HBP as a viable option for patients with non-responders to biventricular therapy and those with AV block and preserved LV function.
3
Evolving role of permanent His bundle pacing in conquering dyssynchrony
Sharma PS, Vijayaraman P · Cardiac Electrophysiology Clinics, 2019
Reviews the mounting evidence for PHBP in correcting ventricular dyssynchrony across multiple pacing indications. Demonstrates significant clinical advantages over conventional right ventricular pacing with respect to heart failure outcomes, LV function, and AF burden.
4
His bundle pacing or biventricular pacing for cardiac resynchronization therapy in heart failure
Sharma PS, Vijayaraman P · Journal of Atrial Fibrillation, 2016
Among the earliest comparative analyses of HBP versus BiV pacing for CRT. Highlighted the 25–30% non-responder rate to BiV therapy, limitations in LV lead placement, and the physiological superiority of direct His bundle activation in LBBB patients.
5
Overcoming left bundle branch block by permanent His bundle pacing: evidence of longitudinal dissociation
Sharma PS, Ellison K, Patel HN, Trohman RG · HeartRhythm Case Reports, 2017
Electrophysiological case series demonstrating that chronic LBBB is caused by intra-Hisian longitudinal dissociation, correctable by selective His bundle pacing. First evidence of this mechanism recorded via a permanent pacing lead — validating the theoretical basis for HBP-mediated LBBB correction.
Advertisement
LBBAP — clinical outcomes
6
Clinical outcomes of LBBAP compared to right ventricular pacing: results from the Geisinger-Rush Conduction System Pacing Registry
Sharma PS, Patel NR, Ravi V et al. · Heart Rhythm, 2022
Multicenter observational registry of 703 patients (321 LBBAP, 382 RVP). LBBAP reduced the composite endpoint of all-cause mortality, heart failure hospitalization, or upgrade to BiV pacing by 54% (HR 0.46, 95% CI 0.31–0.70). Pacing burden above 20% was the primary outcome driver. Narrower paced QRS with LBBAP (121 ms vs. 156 ms with RVP).
7
New-onset atrial fibrillation in LBBAP versus right ventricular pacing
Ravi V, Sharma PS, Patel NR et al. · Heart Rhythm, 2022
Secondary analysis from the Geisinger-Rush CSP Registry demonstrating that LBBAP was associated with significantly lower rates of new-onset atrial fibrillation compared to RVP. Further supports the clinical superiority of physiological ventricular pacing in preserving atrial function.
8
Comparison of LBBAP and biventricular pacing in candidates for resynchronization therapy
Vijayaraman P, Sharma PS, Cano O et al. · Journal of the American College of Cardiology, 2023
International multicenter study at 15 centers, including patients with LVEF ≤35% receiving CRT. LBBAP demonstrated improved survival and fewer heart failure hospitalizations versus BiV pacing, with shorter paced QRS. Represents a major milestone supporting LBBAP as a clinical alternative to standard BiV CRT.
9
LBBAP vs. biventricular pacing for CRT in patients with LVEF ≤50%: I-CLAS Group
Vijayaraman P, Morcos R, Sharma PS et al. · Heart Rhythm, 2024–2025
Largest international propensity-matched LBBAP study to date: 2,579 patients at 18 centers (January 2018–June 2023). LBBAP reduced composite death/HFH by 19% (HR 0.81, p=0.048) and HF hospitalizations by 37% (HR 0.63, p<0.001). Shorter paced QRS (129 ms vs. 143 ms) and fewer procedural complications (3.5% vs. 6.5%).
10
LBBAP for cardiac resynchronization therapy: International LBBAP Collaborative Study Group
Vijayaraman P, Ponnusamy SS, Cano O, Sharma PS et al. · JACC Clinical Electrophysiology, 2021
Multicenter feasibility and outcomes study (325 patients, CRT indications). LBBAP succeeded in 277 patients (85%), with low pacing thresholds and significant improvement in NYHA class and LV ejection fraction. Established LBBAP as a safe, feasible alternative to BiV CRT with durable lead performance.
Advertisement
CSP — special populations & procedures
11
His-Purkinje conduction system pacing following TAVR: feasibility and safety
Vijayaraman P, Cano O, Koruth JS, Sharma PS et al. · JACC Clinical Electrophysiology, 2020
First multicenter study of CSP after transcatheter aortic valve replacement (65 patients, 5 centers). LBBAP achieved 93% success vs. 63% for HBP in the same population. CoreValve prostheses reduced HBP success rates. LBBAP demonstrated superior pacing characteristics post-TAVR and is now the preferred approach.
12
Worldwide survey on implantation and outcomes of conduction system pacing (HBP and LBBAP)
Perino AC, Wang PJ, Sharma PS et al. · Journal of Interventional Cardiac Electrophysiology, 2023
Cross-sectional international survey of 140 institutions on 5 continents (90.7% with CSP experience). Described real-world adoption curves, proceduralist experience stratified by device indication, and outcome benchmarks for both HBP and LBBAP. Essential global reference for CSP implementation.
13
LBBAP in patients with heart failure and right bundle branch block: International LBBAP Collaborative
Vijayaraman P, Herweg B, Verma A, Sharma PS et al. · Heart Rhythm, 2022
Targeted analysis of LBBAP outcomes in patients with RBBB — a traditionally underserved population with limited benefit from conventional CRT. Demonstrated clinical improvement and echocardiographic response, significantly expanding the indications for conduction system pacing.
14
Complications, troubleshooting, and follow-up for left bundle branch area pacing
Sharma PS, Vijayaraman P, Herweg B · Arrhythmia & Electrophysiology Review, 2024
Comprehensive open-access clinical guide covering short- and long-term complications of LBBAP, device programming pearls, troubleshooting algorithms for loss of capture and threshold rise, and structured follow-up protocols. Practical reference for electrophysiologists at all LBBAP experience levels.
Pacing-induced cardiomyopathy (PICM)
15
Feasibility and outcomes of upgrading to LBBP in patients with PICM and infranodal AV block
Ye Y, Wu S, Su L, …Sharma PS, Ellenbogen KA et al. · Heart Rhythm, 2021
Demonstrated that left bundle branch pacing successfully reverses LV dysfunction caused by RV pacing-induced cardiomyopathy, even when His bundle pacing fails due to infranodal AV block. Key evidence for LBBAP upgrade in highly pacing-dependent patients with progressive EF decline — a clinically urgent, underaddressed scenario.
Ablation & advances in electrophysiology
16
Advances in cardiac electrophysiology (multi-author state-of-the-art review)
Piccini JP, Russo AM, Sharma PS et al. · Circulation: Arrhythmia and Electrophysiology, 2022
Landmark state-of-the-art review co-authored by Dr. Sharma alongside 20+ international EP leaders from Duke, Stanford, Columbia, Johns Hopkins, and other top institutions. Covers AF ablation, ventricular tachycardia, implantable devices, and emerging pacing strategies — positioning him among the foremost thought leaders in contemporary electrophysiology.
Advertisement
Frequently Asked Questions
What is His bundle pacing (HBP)?
His bundle pacing (HBP) delivers electrical stimulation directly to the His bundle — the main conduction pathway between the atria and ventricles — resulting in normal, synchronous ventricular activation. Unlike right ventricular apical pacing, HBP avoids ventricular dyssynchrony and the associated risks of heart failure and pacing-induced cardiomyopathy.
What is left bundle branch area pacing (LBBAP)?
LBBAP advances a pacing lead through the interventricular septum to capture the left bundle branch or its fascicles, achieving rapid LV activation via the native His-Purkinje system. It offers higher success rates and more stable pacing thresholds than His bundle pacing, and large registries now show it reduces death and heart failure hospitalizations compared to right ventricular pacing.
What is pacing-induced cardiomyopathy (PICM)?
PICM is defined as a decline in LVEF greater than 10%, resulting in LVEF ≤50%, in patients with an RV pacing burden exceeding 20%. It affects approximately 10–20% of chronically paced patients. Risk factors include male sex, wider paced QRS, high pacing burden, baseline LV dysfunction, and atrial fibrillation. Conduction system pacing (CSP) upgrade — particularly LBBAP — can reverse PICM even in the setting of infranodal AV block.
Is LBBAP better than biventricular pacing for CRT?
Multiple large multicenter studies co-authored by Dr. Sharma suggest yes. The I-CLAS collaborative study (2,579 patients, 18 centers) found LBBAP reduced the composite of death or HF hospitalization by 19% and HF hospitalizations specifically by 37% versus biventricular pacing, with a shorter paced QRS and fewer procedural complications. Randomized controlled trials (including the ongoing LBBP-RESYNC trial) are underway to confirm these findings.
Who is Dr. Parikshit S. Sharma and why does he matter?
Dr. Parikshit S. Sharma, MD, MPH, FACC, FHRS is the Section Head of Electrophysiology at Cleveland Clinic Florida in Weston. A pioneer in conduction system pacing, he previously served as Section Chief of Cardiac Electrophysiology and Director of the EP Lab at Rush University Medical Center. He has published in Nature Reviews Cardiology, JACC, Heart Rhythm, and Circulation: Arrhythmia & Electrophysiology — helping define the clinical evidence base for both His bundle pacing and LBBAP globally.
Advertisement