His Bundle Pacing: State of the Art

Traditional right ventricular pacing can be associated with adverse remodeling, leading to left ventricular dysfunction, functional mitral regurgitation, left atrial dilatation, as well as atrial and ventricular arrhythmias. His bundle pacing (HBP) has emerged as a viable and reliable alternative to right ventricular pacing. HBP has been around since the 1970s, but remained dormant even after the index clinical study in humans in 2000. However, with recently rejuvenated interest, it appears to be a promising strategy for achieving synchronous ventricular pacing. Multiple studies have now shown that HBP is feasible, safe, and offers better outcomes when compared with right ventricular pacing. It has also emerged as an alternative to biventricular pacing for the provision of cardiac resynchronization therapy. This review gives a systematic appraisal of the history, feasibility, safety, techniques, efficacy, benefits, complications, and challenges, and offers a future perspective, of HBP.