[His-bundle stimulation and alternative RV stimulation sites]

The increasing evidence that right ventricular (RV) apical stimulation is detrimental for cardiac mechanics and increases the risk of new onset heart failure and mortality promotes strategies to avoid ventricular pacing and - if not applicable due to atrioventricular block - stipulates the search for alternative techniques of pacing the heart from the right ventricle. Despite more than 15 years of clinical research it remains unclear whether pacing from the right ventricular outflow tract or septum, dual site RV stimulation or selective pacing of the His bundle results in hemodynamic and prognostic benefit over the traditional method of apical RV pacing. The article reviews pertinent literature and tries to demonstrate pathophysiological mechanisms.