His bundle pacing: initial Slovenian single-centre experience

Background: High right ventricular (RV) pacing burden may promote left ventricular dysfunction. Recently, His bundle pacing (HBP) has emerged as an alternative method to RV pacing that provides physiological ventricular activation by directly stimulating the conduction system. Methods: Consecutive 75 patients (male 61.3%, age 65 ± 14 yrs, preserved ejection fraction 53.8%, atrial fibrillation (AF) 56%) in whom HBP was attempted at our centre between May 2018 and September 2020 were included. Acute implant success rate, complications and mid-term outcomes were assessed. Results: Permanent HBP was acutely successful in 69 patients (92%). There were no acute procedure-related complications. Most common indication was AF with rapid ventricular response (38.7%) where HBP was performed in conjunction with atrioventricular node ablation. Median fluoroscopy time was lower during the second half of implants (6.35 (2.7 – 47) vs. 5.4 (1.3 – 13.6) minutes; p = 0.004). His capture parameters remained stable during the median follow-up of 193 (59 – 342) days. Eleven patients (11/69, 15.9%) with initially successful procedure experienced a significant rise in HBP threshold. Three patients (3/69, 4.3%) needed HBP lead revision or deactivation. Conclusion: Our initial experience indicates that HBP is feasible and safe in various pacing indications. Further randomized clinical trials with long-term follow-up are needed to provide the grounds for wider clinical application of this promising physiological pacing technique.