February 20, 2025Arrhythmia & Electrophysiology Review11 citationsOpen Access
His Bundle Pacing in the Era of Left Bundle Branch Pacing
Key Result
His bundle pacing remains a valuable alternative physiological pacing method and an essential rescue option for failed cardiac resynchronization therapy or left bundle branch area pacing.
Structured PICO
Does His bundle pacing offer advantages over left bundle branch area pacing?
I
Intervention
His bundle pacing (HBP)
C
Comparator
Left bundle branch area pacing (LBBAP)
His bundle pacing remains a relevant physiological pacing method and should be maintained as an active program in modern pacing laboratories, particularly as a rescue option for failed CRT or LBBAP.
Limitations
- Late threshold rise and loss of His bundle capture during follow-up
- Undersensing issues and challenging device programming compared to other pacing modalities
- Lack of prospective studies documenting a reduction in late threshold rise with modern implantation techniques
- Need for highly standardized implantation techniques to prevent lead microdislodgement
Abstract
Soon after the rapid growth of the popularity of His bundle pacing (HBP), the use of this conduction system pacing modality was overshadowed by left bundle branch area pacing (LBBAP). This focused review on HBP addresses whether there are any advantages of HBP over LBBAP and what the current uses of HBP may be. We conclude that HBP must be considered as an alternative physiological pacing method with several potential applications, undoubtedly at least as a rescue option for failed CRT/LBBAP. For wider application of HBP, prospective studies are needed to document a reduction in the incidence of late threshold rise with modern implantation techniques. Nevertheless, HBP should be available in every modern pacing laboratory. This requires an active HBP program to maintain and develop the ability of operators to deliver HBP when it is most needed.