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Updated: Feb 16, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

11.1K

His Bundle Pacing Or Biventricular Pacing For Cardiac Resynchronization Therapy In Heart Failure: Discovering New

Parikshit S Sharma1, Pugazhendhi Vijayaraman1

  • 1Rush University Medical Center, Chicago, IL and Geisinger Heart Institute, Wilkes Barre, PA.

Journal of Atrial Fibrillation
|December 19, 2017
PubMed

Insights

Permanent His Bundle pacing (HBP) offers a physiological alternative to biventricular pacing for cardiac resynchronization therapy (CRT). HBP is effective in patients who do not respond to or cannot undergo biventricular pacing for heart failure management.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Heart failure (HF) is a major cardiovascular disease.
  • Cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing improves outcomes in select HF patients with left bundle branch blocks (LBBB).
  • BiV pacing has limitations including lead implantation challenges, non-response, and lack of benefit in certain patient groups (e.g., RBBB, AV block).

Purpose of the Study:

  • To review the physiology of His Bundle pacing (HBP).
  • To evaluate existing data on HBP for CRT.
  • To highlight HBP as a potential alternative to BiV pacing in non-responders or in cases of BiV pacing failure.

Main Methods:

  • Review of physiological principles of HBP.
  • Analysis of clinical data and studies on HBP for CRT.
  • Comparison of HBP outcomes with BiV pacing in challenging HF populations.

Main Results:

  • HBP provides a more physiological ventricular activation compared to BiV pacing.
  • HBP is a feasible alternative for CRT in patients unsuitable for or unresponsive to BiV pacing.
  • HBP can potentially overcome limitations associated with LV lead placement and patient-specific factors affecting BiV pacing response.

Conclusions:

  • His Bundle pacing is a viable and potentially superior alternative for CRT.
  • HBP offers a physiological approach to ventricular pacing, addressing limitations of BiV pacing.
  • HBP expands CRT options for heart failure patients, particularly those with complex conduction abnormalities or previous pacing failures.

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