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Updated: Sep 15, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Early Deterioration of the Right Ventricular Pacing Threshold Predicts the Increase in His-Bundle Pacing Threshold

Kenji Baba1, Shogo Sakamoto1, Moritoshi Irishio1

  • 1Department of Cardiovascular Medicine Bell Land General Hospital Osaka Japan.

Journal of Arrhythmia
|July 16, 2025
PubMed

Insights

Early detection of elevated right ventricular (RV) pacing thresholds and lead bending can predict long-term His-bundle pacing (HBP) threshold deterioration. Close monitoring and output adjustments are crucial for preventing pacing failure.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • His-bundle pacing (HBP) offers physiological ventricular activation but faces concerns regarding long-term threshold stability.
  • Predictors for chronic threshold elevation in HBP are not well-established, necessitating further investigation.

Purpose of the Study:

  • To identify predictors of chronic threshold deterioration in His-bundle pacing (HBP).
  • To assess the long-term pacing thresholds of HBP and correlate them with lead characteristics and early pacing parameters.

Main Methods:

  • A cohort of 95 patients undergoing HBP implantation was studied, with 47 successfully paced patients monitored for over 3 years.
  • Pacing thresholds for His-bundle and right ventricle (RV) were assessed at implantation, 1 week, 1 month, and annually.
  • Lead shape was evaluated via radiography, and patients were grouped by HBP threshold stability.

Main Results:

  • Deterioration in HBP thresholds correlated with increased RV pacing thresholds, with RV deterioration noted earlier (1 week post-implantation).
  • An elevated RV threshold (≥3.0 V/0.4 ms) at 1 week and lead bending on radiography were independent predictors of chronic HBP threshold deterioration.
  • Multivariate analysis revealed significant odds ratios for RV threshold and lead bending predicting deterioration.

Conclusions:

  • Elevated RV pacing thresholds at 1 week and lead flexion are early indicators of potential long-term HBP threshold decline.
  • Close patient monitoring and timely adjustment of pacing output are essential upon detecting increased RV pacing thresholds to prevent pacing failure.
Abstract

Keywords:
capture thresholdconduction system pacinghis‐bundle pacinglead slackpacemaker

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