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J Am Coll Cardiol. 2018 Aug 21;72(8):927-947. doi: 10.1016/j.jacc.2018.06.017.

His Bundle Pacing.

Author information

1
Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania. Electronic address: pvijayaraman1@geisinger.edu.
2
Division of Electrophysiology, Cleveland Clinic, Cleveland, Ohio.
3
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
4
Electrophysiology Section, Division of Cardiology, University of Chicago, Chicago, Illinois.
5
Electrophysiology Section, Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
6
Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
7
Division of Cardiology, Duke University, Durham, North Carolina.
8
Division of Electrophysiology, University of California San Francisco, California.
9
Electrophysiology Section, Division of Cardiology, American University of Beirut, Beirut, Lebanon.
10
Electrophysiology Research Foundation, Warren, New Jersey; Rutgers' Robert Wood Johnson Medical School, New Brunswick, New Jersey.
11
Electrophysiology Section, Division of Cardiology, Albert Einstein College of Medicine, New York, New York.
12
Kansas City Heart Rhythm Institute, Overland Park, Kansas; University of Missouri, Columbia, Missouri.

Abstract

Traditional right ventricular (RV) pacing for the management of bradyarrhythmias has been pursued successfully for decades, although there remains debate regarding optimal pacing site with respect to both hemodynamic and clinical outcomes. The deleterious effects of long-term RV apical pacing have been well recognized. This has generated interest in approaches providing more physiological stimulation, namely, His bundle pacing (HBP). This paper reviews the anatomy of the His bundle, early clinical observations, and current approaches to permanent HBP. By stimulating the His-Purkinje network, HBP engages electrical activation of both ventricles and may avoid marked dyssynchrony. Recent studies have also demonstrated the potential of HBP in patients with underlying left bundle branch block and cardiomyopathy. HBP holds promise as an attractive mode to achieve physiological pacing. Widespread adaptation of this technique is dependent on enhancements in technology, as well as further validation of efficacy in large randomized clinical trials.

KEYWORDS:

cardiac resynchronization therapy; heart failure; permanent His bundle pacing; right ventricular pacing

PMID:
30115232
DOI:
10.1016/j.jacc.2018.06.017

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