His bundle pacing provides physiological stimulation that engages electrical activation of both ventricles, avoiding marked dyssynchrony associated with traditional right ventricular pacing.
Does His bundle pacing provide more physiological stimulation and avoid dyssynchrony compared to traditional right ventricular pacing in patients with bradyarrhythmias?
His bundle pacing offers a promising physiological alternative to traditional right ventricular pacing, potentially avoiding pacing-induced dyssynchrony, though large randomized trials are needed.
Traditional right ventricular (RV) pacing for the management of bradyarrhythmias has been pursued successfully for decades, although there remains debate regarding optimal pacing site with respect to both hemodynamic and clinical outcomes. The deleterious effects of long-term RV apical pacing have been well recognized. This has generated interest in approaches providing more physiological stimulation, namely, His bundle pacing (HBP). This paper reviews the anatomy of the His bundle, early clinical observations, and current approaches to permanent HBP. By stimulating the His-Purkinje network, HBP engages electrical activation of both ventricles and may avoid marked dyssynchrony. Recent studies have also demonstrated the potential of HBP in patients with underlying left bundle branch block and cardiomyopathy. HBP holds promise as an attractive mode to achieve physiological pacing. Widespread adaptation of this technique is dependent on enhancements in technology, as well as further validation of efficacy in large randomized clinical trials.
“There is no evidence base for His-bundle pacing, although many people do it, and we thought that it's probably premature to be included as a class I or class II indication. So we left it only for patients who fail CRT and otherwise for patients with ejection fraction that is above [the threshold for] CRT but below normal—they may benefit from His-bundle pacing instead of RV apical pacing, but we gave it a [class] IIb indication because the jury is still out.”
Vijayaraman et al. (2018) conducted a review in Bradyarrhythmias. His bundle pacing (HBP) vs. Right ventricular (RV) pacing was evaluated. His bundle pacing provides physiological stimulation that engages electrical activation of both ventricles, avoiding marked dyssynchrony associated with traditional right ventricular pacing.