What patient characteristics might contraindicate conduction system pacing?

Severe comorbid conditions can significantly contraindicate conduction system pacing due to the increased complexity and risk associated with the procedure. Patients with severe comorbidities may have underlying health issues that complicate anesthesia, increase the risk of adverse outcomes during and after the procedure, or lead to a higher likelihood of complications post-implantation, such as infections or device malfunction. These patients may also have a reduced physiological reserve, making them less able to tolerate the stress of the procedure or recover adequately afterward.

In contrast, mild chronic conditions generally do not pose the same level of risk and may not significantly impact the safety and efficacy of conduction system pacing. Age alone, while a factor to consider, does not inherently preclude patients from receiving this form of pacing—there are many elderly patients who are suitable candidates. Obesity may increase some risks, but it's not an absolute contraindication as approaches can be adjusted to accommodate such patients. Hence, the presence of severe comorbidities is the primary reason influencing the decision against conduction system pacing.