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

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Conventional right ventricular (RV) apical pacing can lead to adverse effects like atrial fibrillation, heart failure hospitalizations, and pacing-induced cardiomyopathy.
• Long-term RV apical pacing is linked to increased mortality.
• His bundle pacing (HBP) directly stimulates the His-Purkinje network, promoting physiological ventricular activation.

Purpose of the Study:

• To review the anatomy of the His bundle.
• To discuss early clinical observations and implantation techniques for permanent HBP.
• To summarize available outcome data, challenges, and future directions for HBP.

Main Methods:

• Review of existing literature on His bundle anatomy, pacing techniques, and clinical outcomes.
• Analysis of data regarding HBP's impact on ventricular activation and potential benefits in cardiac resynchronization therapy.
• Identification of challenges and limitations associated with permanent HBP.

Main Results:

• HBP results in synchronized ventricular activation, contrasting with dyssynchronous activation from RV apical pacing.
• HBP can effectively manage bundle branch block patterns.
• Emerging data suggest potential benefits of HBP for cardiac resynchronization therapy.

Conclusions:

• HBP offers a more physiological approach to ventricular pacing compared to RV apical pacing.
• While promising, widespread adoption of permanent HBP requires further investigation into its long-term outcomes and the development of additional supportive tools.
• Randomized controlled trials are essential to validate the clinical benefits of HBP.