Concierge cardiology · London
Conduction system pacing, by an electrophysiologist who does them regularly.
Physiological pacing — His-bundle or left bundle branch area — that keeps your ventricles contracting together. A named electrophysiologist, a proper cath lab, and a fair comparison with conventional pacing and CRT before you consent.
Why patients choose us
- 01
A consultant electrophysiologist with CSP experience
A named cardiac electrophysiologist who implants His-bundle and left bundle branch area leads on a regular list — not an occasional operator learning on your case.
- 02
Physiological pacing considered first
For the right patient, CSP preserves the heart’s own conduction. We say when it beats conventional right ventricular pacing, and when it doesn’t.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — HBP, LBBAP, RV pacing or biventricular CRT — is impartial and costs you nothing.
Indicative pricing
What conduction system pacing costs privately in London.
Indicative ranges across our partner cath labs. Send the details and we quote firm figures across two or three options.
In short
An HBP or LBBAP implant in our network: £12,000–£18,000, home the next morning.
| Procedure | Indicative range | Typical duration | Discharge |
|---|---|---|---|
| Electrophysiology consultation | £250–£450 | 45 min | Same visit |
| His-bundle pacing (HBP) implant | £12,000–£18,000 | 90–150 min | Overnight stay |
| Left bundle branch area pacing (LBBAP) | £12,000–£18,000 | 90–150 min | Overnight stay |
| CRT upgrade to LBBAP | £14,000–£22,000 | 120–180 min | Overnight stay |
| Conventional dual-chamber pacemaker | £9,000–£14,000 | 60–90 min | Same day / overnight |
| Biventricular CRT device | £18,000–£28,000 | 150–210 min | Overnight stay |
Prices vary by clinic, by which electrophysiologist does the case, by the device manufacturer and generator chosen, and by whether it is a first implant or an upgrade. We come back with a firm quote within one working day.
The problem
The right operator, the right lead, the right physiology.
Conduction system pacing is a genuinely operator-dependent procedure and the evidence is still moving. Booked badly, it becomes an expensive RV lead. Booked well, it can outperform decades of conventional pacing.
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Is CSP even right for you?
For low-burden pacing, a straightforward dual-chamber system may be enough. We say so before you agree to a more complex implant.
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Which lead — HBP or LBBAP?
HBP is the most physiological; LBBAP is more forgiving on thresholds. The choice is patient-specific, not a house preference.
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Vs CRT, or after failed CRT?
In HF with LBBB, CSP is used both as an alternative to biventricular pacing and as a rescue when CRT has not worked.
The journey
From enquiry to implant — what happens, in order.
One electrophysiologist from first consultation to device follow-up.
Phase 1 · Before your implant
Concierge, off-stage for you
Phase 2 · On the day
Cath lab and overnight
Phase 3 · After
Device clinic and remote
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, ECGs, echo results, and whether a pacemaker or CRT has already been discussed.
- 02
Before
We come back with a recommendation
Within one working day: whether CSP is a fair option for you, which operator to see, an indicative price and a fair comparison with conventional pacing.
- 03
Before
Electrophysiology consultation
A face-to-face review — history, medications, previous rhythm strips and imaging. The electrophysiologist confirms the indication and plans the lead strategy.
- 04
On the day
Arrival at the cath lab
Admission, consent and marking. Local anaesthetic with light sedation is the norm; general anaesthesia is rarely needed.
- 05
On the day
The implant itself
A transvenous approach via the subclavian or axillary vein. A specialised lumen-less lead is screwed into the interventricular septum toward the conduction system, with continuous ECG and pacing checks.
- 06
On the day
Overnight observation
A chest X-ray and device check confirm lead position and thresholds. Most patients go home the next morning with a sling and clear wound advice.
- 07
After
Follow-up and remote monitoring
A wound and device check at 4–6 weeks, then remote monitoring with in-person reviews at 3, 6 and 12 months to track thresholds and cardiac function.
Typical end-to-end: 2–4 weeks from enquiry to implant. First device review: 4–6 weeks after.
When it helps
When conduction system pacing is the right step.
The situations where CSP is genuinely worth considering, plus the one red flag that means an emergency rather than an appointment.
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High-burden RV pacing expected
AV block or ablate-and-pace for AF where the ventricle will be paced most of the time — the setting where CSP most clearly protects LV function.
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Complete or high-grade AV block
When a pacemaker is needed and the ventricle will be paced constantly, CSP preserves synchrony better than an RV apex lead.
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Heart failure with LBBB
An alternative or complement to biventricular CRT in patients with left bundle branch block and reduced LV function.
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Failed or non-responder CRT
When a biventricular device has not delivered the expected clinical or echo response, LBBAP is an increasingly used rescue strategy.
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AF with ablate-and-pace strategy
For refractory atrial fibrillation treated by AV node ablation, CSP avoids the pacing-induced cardiomyopathy risk of an RV lead.
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Pacing-induced cardiomyopathy
An existing right ventricular pacing lead that has driven a fall in LV function — an upgrade to LBBAP can recover it in the right patient.
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Younger patients needing lifelong pacing
When the ventricle will be paced for decades, physiological pacing has a stronger case than conventional RV apical pacing.
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Red flag: syncope with high-grade block
Blackouts with second- or third-degree AV block are an emergency — same-day A&E for temporary pacing, not an outpatient booking.
Pacing options
CSP is not the only option.
What each pacing option actually involves — and which fits which problem.
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His-bundle pacing (HBP)
A lead placed at the His bundle so the heart’s own conduction system carries the impulse. Most physiological, but capture thresholds can be higher and less stable long-term.
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Left bundle branch area pacing (LBBAP)
A lead screwed deep into the interventricular septum to capture the left bundle. Lower, more stable thresholds than HBP and now the most-used CSP technique.
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Conventional RV apical pacing
The traditional right ventricular lead. Reliable and quick to implant, but a high pacing burden can lead to dyssynchrony and pacing-induced cardiomyopathy.
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RV septal pacing
A mid-septal RV lead. Marginally more physiological than apical pacing but does not engage the conduction system in the way CSP does.
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Biventricular CRT
A left ventricular lead via the coronary sinus, added to atrial and RV leads. The established treatment for HF with LBBB, and the comparator CSP is measured against.
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CRT upgrade to LBBAP
Replacing or complementing a failed CRT with a left bundle branch area lead. A growing option for non-responders.
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Leadless pacemaker
A capsule fixed inside the right ventricle with no wires or pocket. Not a CSP option, but relevant when vascular access or infection risk rules out a conventional system.
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Consultation only
An honest discussion of whether CSP is right for you at all, and how it compares with the alternatives — no obligation.
Our vetted London network
A small panel of electrophysiologists, we picked them.
Consultant cardiac electrophysiologists across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every electrophysiologist in our network.
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Consultant cardiac electrophysiologists with a regular CSP implant list
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Cardiac catheter lab with continuous ECG mapping and fluoroscopy
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Dedicated device clinic with remote monitoring and 24/7 lead-fail cover
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Formal fair comparison of CSP against conventional pacing and CRT before consent
Safety and recovery
What to expect — honestly.
CSP is a safe procedure in experienced hands, but it is more technically demanding than a conventional pacemaker. The risks worth understanding are lead-related, and follow-up matters more than usual.
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Local anaesthetic and light sedation
The implant is done under LA to the pocket area, usually with light sedation. General anaesthesia is rarely needed.
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Overnight stay is normal
A chest X-ray, wound review and device interrogation happen the morning after. Most patients go home within 24 hours.
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Sling for the arm on the implant side
The arm is rested in a sling for 24–48 hours and lifting is limited for 4–6 weeks so the lead can bed in.
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Threshold rise is a known issue
Capture thresholds — especially with His-bundle pacing — can drift up over time. Regular device checks catch this and the settings are adjusted.
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Septal perforation, uncommon
The lead can occasionally cross the full thickness of the septum. It is picked up on the day, the lead is repositioned and the outcome is usually excellent.
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Lead dislodgement, in the first few weeks
Rare after the first month. Following the arm-rest and lifting advice is the single best thing you can do to prevent it.
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Pericardial effusion and tamponade
A very rare but serious complication of septal lead work. Cath labs are prepared for it and outcomes are good when it is recognised early.
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Device infection
Uncommon but important — redness, swelling or discharge at the pocket weeks or months later should always be reviewed.
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Red flags
Blackouts, sudden breathlessness, fever, spreading pocket redness, or return of the original heart failure symptoms are not normal — call the device team or A&E the same day.
Reading your implant note
Your implant note in four parts. Read the last one first.
Whichever technique was used, the note the electrophysiologist sends you keeps to the same shape.
A quiet reminder
Device language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your device check, just ask.
- 01 Header
Indication and lead strategy chosen
Why CSP was preferred — AV block, ablate-and-pace, HF with LBBB, failed CRT — and whether HBP or LBBAP was used.
- 02 Technique
Access, lead, and mapping detail
Venous access site, sheath and lumen-less lead used, mapping findings, capture thresholds and paced QRS morphology.
- 03 Findings
Thresholds, sensing and impedance
Final capture threshold, R-wave sensing and lead impedance at implant, plus any repositioning during the case.
- 04 Impression
Programming, follow-up and remote monitoring
Read this first: how the device is programmed, when to be checked, and how remote monitoring will pick up any drift.
Recognised by major UK insurers
Cover for conduction system pacing varies by insurer and by indication — usually funded when medically indicated by AV block, heart failure or a failing conventional device. We confirm cover and any excess before booking.
Frequently asked
Everything we get asked about conduction system pacing.
Quick answers on what CSP is, how it compares with CRT, cost, risks and recovery.
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What is conduction system pacing?
Conduction system pacing (CSP) uses the heart’s own electrical wiring — either the His bundle (HBP) or the left bundle branch area (LBBAP) — instead of pacing the tip of the right ventricle. The aim is to keep the two ventricles contracting together, as they were designed to.
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Why might CSP be better than a conventional pacemaker?
When the ventricle will be paced most of the time — for AV block, or after an AV node ablation for AF — conventional RV apical pacing can, over years, weaken the left ventricle. CSP preserves electromechanical synchrony and reduces the risk of pacing-induced cardiomyopathy.
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How is CSP different from biventricular CRT?
CRT uses a lead in the coronary sinus to pace the outside of the left ventricle. CSP paces the conduction system itself with a single well-placed lead. In heart failure with LBBB, CSP is used either as an alternative to CRT or as a rescue when CRT has not worked.
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How is a CSP lead put in?
Through a vein under the collarbone, under local anaesthetic and light sedation. A specialised lumen-less lead is screwed into the interventricular septum, aiming for the His bundle or the left bundle branch area, with continuous ECG guidance to confirm capture of the conduction system.
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How much does private CSP cost in London?
Roughly £12,000–£18,000 for an HBP or LBBAP implant, £14,000–£22,000 for a CRT upgrade to LBBAP, and £18,000–£28,000 for a full biventricular CRT device. A consultation is £250–£450. We confirm a firm figure within one working day.
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Who is CSP suitable for?
High-burden right ventricular pacing (AV block, ablate-and-pace for AF), heart failure with LBBB as an alternative to CRT, upgrades from a failed CRT, and existing patients who have developed pacing-induced cardiomyopathy on an RV lead.
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What are the main risks?
Septal perforation, lead dislodgement in the first few weeks, a rise in capture threshold over time, pericardial effusion or tamponade, device infection and — as with any pacemaker — the small chance the device does not deliver the expected clinical response.
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How long is the recovery?
Overnight in hospital, arm in a sling for 24–48 hours, and no heavy lifting or driving for 4–6 weeks. Most people are back to office work within a week and to full activity by six.
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How is follow-up done?
A wound and device check at 4–6 weeks, then remote monitoring with in-person reviews at 3, 6 and 12 months. Thresholds are re-measured and the device is reprogrammed if they have drifted.
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When should I seek urgent help?
Blackouts, sudden breathlessness, chest pain, fever, or spreading redness and discharge at the device pocket are all reasons to call the device team or A&E the same day.
Related tests
Looking for something else?
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Holter monitor
24–72 hour ambulatory heart rhythm recording.
Learn more -
Ambulatory ECG
Longer-term rhythm monitoring for intermittent symptoms.
Learn more -
Echocardiogram
Ultrasound of the heart to assess LV function.
Learn more -
All tests
Every test and procedure we arrange.
Learn more -
Hypertension
Related condition guide.
Learn more -
Atrial Fibrillation
Related condition guide.
Learn more -
ECG
Related diagnostic test.
Learn more
In practice, in London
The honest picture around conduction system pacing in London
For conduction system pacing, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Public provision for conduction system pacing is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics — Marylebone, the City, Chelsea, Canary Wharf — means most patients can find something that fits around work without a cross-town trek. For conduction system pacing in particular, we bias towards consultants who do this every week rather than every month.
Fit matters more than people expect. For conduction system pacing, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.