Insights from 10-year follow-up of His bundle pacing: A multicenter experience

His bundle pacing (HBP) provides physiological ventricular activation by engaging the native His-Purkinje system. Although midterm safety and efficacy are established, long-term outcomes beyond 5 years remain insufficiently defined.

This study aimed to evaluate long-term performance, device behavior, and clinical outcomes of permanent HBP over a follow-up period of up to 10 years.

We retrospectively analyzed 500 consecutive patients who underwent successful HBP between 2003 and 2013 at 2 high-volume centers. Clinical, device, and echocardiographic data were collected at scheduled in-person and remote evaluations. Outcomes included pacing thresholds, sensing, lead-related events, device longevity, left ventricular ejection fraction (LVEF), hospitalizations, and mortality. Time-to-event analyses were performed using Kaplan-Meier estimates and Cox regression.

Follow-up data were available for 487 patients (mean age 75 ± 9 years) with a mean duration of 7.9 ± 4.7 years; 193 patients completed ≥10 years of follow-up. Selective HBP was achieved in 51%. Lead-related events occurred in 12.1% of patients, most commonly capture threshold rise (10.5%); lead dislodgment was rare (0.8%). Battery depletion occurred in 66.6% at 10 years. Backup leads were associated with reduced device longevity (hazard ratio 1.87; P < .001). Overall, LVEF remained stable; 30.7% showed ≥5% improvement in LVEF, particularly among those with a baseline LVEF of <45%. All-cause mortality was 38.2%, predominantly noncardiac.

This large multicenter experience demonstrates that HBP is a safe and effective pacing strategy with durable performance, acceptable device longevity, and stable ventricular function over a decade of follow-up. Technical issues-primarily threshold rise-are generally manageable. These findings provide the longest longitudinal data to date supporting HBP as a reliable physiological pacing modality.