His bundle pacing: conduction system capture and clinical impact
Vatsal Ladia1, Komandoor Srivathsan, Siva Mulpuru
1Department of Cardiovascular Disease, Division of Cardiac Electrophysiology, Mayo Clinic, Phoenix, Arizona Department of Cardiovascular Disease, Division of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
His bundle pacing (HBP) is an emerging alternative for patients needing chronic ventricular pacing. Ongoing studies will soon provide evidence supporting native conduction system pacing for improved outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) has been available for nearly two decades.
- Recent inclusion in guidelines and ongoing research highlight its growing importance.
Purpose of the Study:
- To review the impact of His bundle pacing on clinical practice.
- To assess the current evidence and future directions for HBP.
Main Methods:
- Review of published literature and randomized pilot studies.
- Analysis of clinical outcomes and comparisons with other pacing techniques.
Main Results:
- HBP is established as a feasible pacing alternative, included in clinical guidelines.
- Studies compare selective and non-selective HBP, and HBP against cardiac resynchronization therapy.
Conclusions:
- HBP is a valuable addition to cardiac resynchronization techniques.
- Long-term outcomes in large populations with low ejection fraction require further investigation.
- Future studies are expected to provide robust evidence for native conduction system pacing.
Purpose Of Review:
It has been nearly 2 decades since His bundle pacing (HBP) was described and with very first randomized pilot study published, reviewing its impact on clinical practice is inevitable.
Recent Findings:
Inclusion of HBP in the guidelines, along with long-term outcomes, outcomes comparing selective and non selective HBP and investigator initiated randomized pilot comparing with cardiac resynchronization therapy, HBP has established itself as a feasible pacing alternative.
Summary:
HBP is an addition to the current armada of resynchronization techniques. HBP is an emerging area of interest, and is particularly relevant in patients, who require chronic ventricular pacing, but the long-term outcomes of this approach in large patient populations with low ejection fraction are still lacking. With several ongoing studies, in the near future we will have good-quality evidence to support native conduction system pacing as a viable alternative to improve meaningful outcomes.
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