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Long-Term Prognosis and Outcomes in Patients Undergoing His Bundle Pacing Implantation　- A Multicenter, Prospective

Satoshi Yanagisawa1,2, Hiroyuki Kato3, Yasunori Kanzaki4

  • 1Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 7, 2026
PubMed

Insights

His bundle pacing (HBP) in Japan showed moderate success, with improvements in heart function but challenges in implantation and patient adherence. Careful patient selection and monitoring are crucial for optimal outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • His bundle pacing (HBP) offers an ideal ventricular activation pattern.
  • Long-term efficacy and clinical outcomes of HBP in Japan are not well-established.

Purpose of the Study:

  • To evaluate the long-term efficacy and clinical outcomes of His bundle pacing in a Japanese population.
  • To identify predictors of major adverse clinical events (MACE) after HBP implantation.

Main Methods:

  • A multicenter prospective observational study involving 115 patients undergoing HBP implantation in Japan.
  • Follow-up duration of 3 years, assessing primary endpoints (mortality, heart failure hospitalization, CRT upgrade) and secondary endpoints (echocardiographic and biomarker changes).
  • Inclusion criteria: atrioventricular block or conduction disturbance with anticipated ≥40% ventricular pacing.

Main Results:

  • Procedural success was achieved in 68% of patients, and clinical success in 59%.
  • Significant improvements in echocardiographic parameters and decreased brain natriuretic peptide (BNP) levels were observed at 6 months.
  • Major adverse clinical events (MACE) occurred in 21% of patients, with elevated baseline BNP levels predicting MACE.

Conclusions:

  • HBP implantation faces technical challenges and demonstrates moderate real-world success rates.
  • High rates of elevated capture thresholds and HBP abandonment necessitate careful patient selection.
  • Rigorous long-term surveillance is essential for patients undergoing HBP.
Abstract

Keywords:
Atrioventricular blockCardiovascular implantable electronic deviceConduction system pacingHis bundle pacingPacemaker

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