Key result
His bundle pacing improves synchronization and functional status over conventional pacing despite unproven long-term mortality benefits.
Why the study?
Superiority of His bundle pacing regarding mortality has not been consistently demonstrated, and its long-term efficacy and safety remain to be proven.
Does His bundle pacing improve clinical and functional outcomes compared to conventional pacing in patients requiring anti-bradycardic pacing?
Does His bundle pacing improve clinical and functional outcomes compared to conventional pacing in patients requiring anti-bradycardic pacing?
His bundle pacing is a promising physiological alternative to conventional pacing that may improve ventricular synchronization, LVEF, and heart failure outcomes, though long-term safety and mortality benefits require further study.
His bundle pacing (HBP) is proven to be a safe and effective alternative pacing modality that, in addition, avoids pacemaker-induced cardiomyopathy (PICM) by achieving a “physiological” ventricular stimulation, via the native conduction system. Indications include various causes of bradycardia requiring anti-bradycardic pacing, inadequately controlled atrial fibrillation requiring AV node ablation and established PICM. In addition, HBP may also be used as an alternative therapy for patients with heart failure (HF) and an indication for cardiac resynchronization therapy (CRT). Available data show several advantages of HBP with regard to preservation or restoration of intra- and inter-ventricular synchronization; improvement in left ventricular ejection fraction, functional status and quality of life; decrease in atrial fibrillation incidence and improvement in HF hospitalization rates, compared with conventional pacing. Nevertheless, superiority in terms of mortality rates has not been consistently demonstrated, and the long-term efficacy and safety of HBP remain to be proven. In the present manuscript, we review the status of HBP and present our current experience with this novel pacing modality.
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Archontakis et al. (2021) conducted a review in Bradycardia, heart failure, atrial fibrillation. His bundle pacing (HBP) vs. Conventional pacing was evaluated. His bundle pacing provides a physiological alternative to conventional pacing that improves ventricular synchronization and functional status, though long-term mortality benefits remain unproven.
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