Key result
His bundle pacing capture thresholds increased slightly from 1.1 V at 4 weeks to 1.3 V at 33 months, but pacing energy remained stable through programming optimization.
Why the study?
High capture thresholds and lead dislodgment are often cited as impediments to the general adoption of His bundle pacing.
Observational (n=1,188)
No
His bundle pacing demonstrates stable long-term energy requirements and acceptable lead dislodgment rates when pacing parameters are optimized, though approximately 16% of patients develop high thresholds requiring higher output batteries.
Answers are grounded in this paper and cite their sources.
Supports durable His bundle pacing with optimized parameters in selected patients; leaves open confirmation of battery longevity in randomized trials.
Background: High capture thresholds and lead dislodgment are often cited as impediments for general adoption of His bundle pacing. Objective: We report on our experience in managing patients who underwent His bundle pacing with higher energy requirement and incidence of lead dislodgment in a mean duration of 33 months. Methods: In 1188 patients, pacing was done at the site of His bundle electrogram and capture of conduction axis was confirmed by paced complex demonstrating normal or more normal QRS voltage, QRS axis, and ventricular activation time. Patients were followed for 33 months with routine programming changes to optimize battery longevity. Results: remained unchanged at 0.003 mJ from 4 weeks to 33 months. Two volts or higher threshold was found in 92 patients (11%) at 4 weeks and in 151 patients (16%) at 33 months. The average predicted battery life was 8.5 years. Lead dislodgment occurred in 15 patients (1.2%). Conclusion: In His bundle pacing, the increase in capture threshold over time can be managed by optimizing pacing pulse duration and polarity. The dislodgment rates of Medtronic 3830 lead are not unlike those reported for myocardial pacing. Our study calls attention to the >2 V threshold in 16% of patients and the need for higher output pacemaker batteries.
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Mohan et al. (2025) conducted an observational in Guideline-based indications for pacing (e.g., sinus node dysfunction, complete heart block, heart failure) (n=1,188). His bundle pacing vs. Baseline (4 weeks post-implant) was evaluated on His bundle capture threshold (V) (p=<0.001). His bundle pacing capture thresholds increased slightly from 1.1 V at 4 weeks to 1.3 V at 33 months, but pacing energy remained stable through programming optimization.
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