• DOI:10.1038/s41569-019-0224-z
• Corpus ID: 195698761

Permanent His bundle pacing: shaping the future of physiological ventricular pacing

@article{Sharma2019PermanentHB,
  title={Permanent His bundle pacing: shaping the future of physiological ventricular pacing},
  author={Parikshit S. Sharma and Pugazhendhi Vijayaraman and Kenneth A. Ellenbogen},
  journal={Nature Reviews Cardiology},
  year={2019},
  volume={17},
  pages={22-36}
}

• Parikshit S. Sharma, P. Vijayaraman, K. Ellenbogen
• Published 27 June 2019
• Medicine
• Nature Reviews Cardiology

Conventional right ventricular (RV) pacing, particularly RV apical pacing, can have deleterious effects on cardiac function. Long-term RV apical pacing has been associated with increased risk of atrial fibrillation, hospitalization for heart failure, pacing-induced cardiomyopathy and associated death. His bundle pacing (HBP) results in physiological ventricular activation and has generated tremendous research interest and enthusiasm. By stimulating the His–Purkinje network directly, HBP results in synchronized ventricular activation, which might translate into improved clinical outcomes compared with dyssynchronous ventricular activation with RV apical pacing. HBP can also overcome bundle branch block patterns, and data are accumulating on the benefit of HBP for cardiac resynchronization therapy. In this Review, we summarize the anatomy of the His bundle and early clinical observations, implantation techniques and available outcome data associated with permanent HBP. We also highlight the challenges with HBP and the need for additional tools and more randomized data before widespread application of permanent HBP. By stimulating the His–Purkinje network directly, His bundle pacing results in synchronized, physiological ventricular activation, which might improve clinical outcomes compared with the use of right ventricular apical pacing. Sharma and colleagues summarize early clinical observations, implantation techniques and outcome data with permanent His bundle pacing. Conventional right ventricular apical pacing has been associated with adverse clinical outcomes, including atrial fibrillation, heart failure and death. His bundle pacing (HBP) is a physiological form of pacing and has been shown to improve clinical outcomes compared with conventional right ventricular pacing. HBP can potentially correct bundle branch block in patients with proximal bundle branch disease. Early data suggest that His cardiac resynchronization therapy (CRT) might be at least as effective as biventricular CRT (among patients with a low left ventricular ejection fraction), but large randomized trials are needed to assess its true clinical benefit. A continued need exists for improvement in lead design, delivery tools and devices to increase the success rates of HBP.