Permanent His Bundle Pacing: The Past, Present, and Future

Long‐term right ventricular (RV) apical pacing has been associated with an increased risk of death, heart failure, and atrial fibrillation (AF). Alternative sites for RV pacing have not proven to be superior to RV apical pacing. Cardiac resynchronization therapy (CRT) using a biventricular (BiV) lead system is indicated for patients with a low left ventricular ejection fraction and QRS prolongation, but there remains about a 25–30% nonresponse rate. CRT has been less effective for nonleft bundle branch block conduction delay and with normal/low normal left ventricular function. Over the past decade, there have been more data on the feasibility and advantages of pacing at the His Bundle (HB) region. We review the anatomy and physiology of the HB, the available data on permanent HB pacing, its current and potential future applications.

[1]  B. Scherlag,et al.  A technique for ventricular pacing from the His bundle of the intact heart. , 1967, Journal of applied physiology.

[2]  G. Dandamudi,et al.  How to Perform Permanent His Bundle Pacing: Tips and Tricks , 2016, Pacing and clinical electrophysiology : PACE.

[3]  David O. Martin,et al.  Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. , 2002, JAMA.

[4]  L. Goldman,et al.  Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. , 2002, The New England journal of medicine.

[5]  J. Blanc,et al.  Characteristics of a large sample of candidates for permanent ventricular pacing included in the Biventricular Pacing for Atrio-ventricular Block to Prevent Cardiac Desynchronization Study (BioPace). , 2014, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[6]  Weijian Huang,et al.  Pacing and sensing optimization of permanent His-bundle pacing in cardiac resynchronization therapy/implantable cardioverter defibrillators patients: value of integrated bipolar configuration. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[7]  B J Scherlag,et al.  Catheter Technique for Recording His Bundle Activity in Man , 1969, Circulation.

[8]  K. Ellenbogen,et al.  Acute His‐Bundle Injury Current during Permanent His‐Bundle Pacing Predicts Excellent Pacing Outcomes , 2015, Pacing and clinical electrophysiology : PACE.

[9]  J. Daubert,et al.  The effect of cardiac resynchronization on morbidity and mortality in heart failure. , 2005, The New England journal of medicine.

[10]  H. Jensen,et al.  His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. , 2014, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[11]  R. Lobel,et al.  His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison. , 2015, Heart rhythm.

[12]  B. Scherlag,et al.  Analysis of the A‐V Conduction Defect in Complete Heart Block Utilizing His Bundle Electrograms , 1970, Circulation.

[13]  M. Santini,et al.  Safety and Performance of a System Specifically Designed for Selective Site Pacing , 2011, Pacing and clinical electrophysiology : PACE.

[14]  F. Maroto-Monserrat,et al.  [Permanent His-bundle pacing in patients with infra-Hisian atrioventricular block]. , 2006, Revista espanola de cardiologia.

[15]  O. Narula.  Longitudinal Dissociation in the His Bundle Bundle Branch Block due to Asynchronous Conduction within the His Bundle in Man , 1977, Circulation.

[16]  K. Rosen,et al.  Normalization of Bundle Branch Block Patterns by Distal His Bundle Pacing: Clinical and Experimental Evidence of Longitudinal Dissociation in the Pathologic His Bundle , 1978, Circulation.

[17]  G. Amit,et al.  Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[18]  Wojciech Zareba,et al.  Cardiac-resynchronization therapy for the prevention of heart-failure events. , 2009, The New England journal of medicine.

[19]  D. Casavant,et al.  Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. , 2000, Circulation.

[20]  G. Lamas,et al.  Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction , 2003, Circulation.

[21]  Tomokazu Kawashima,et al.  A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts , 2005, Surgical and Radiologic Anatomy.

[22]  A. Curtis,et al.  Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing: The BLOCK HF Study. , 2016, Journal of the American College of Cardiology.

[23]  P. Marino,et al.  Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. , 2006, Journal of the American College of Cardiology.

[24]  K. Ellenbogen,et al.  Imaging evaluation of implantation site of permanent direct His bundle pacing lead. , 2014, Heart Rhythm.

[25]  P. Moriña-Vázquez,et al.  Permanent His-bundle pacing: seeking physiological ventricular pacing. , 2010, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[26]  K. Ellenbogen,et al.  Permanent His-bundle pacing in patients with prosthetic cardiac valves. , 2017, Heart rhythm.

[27]  Pablo Moriña-Vázquez,et al.  Estimulación hisiana definitiva en pacientes con bloqueos infrahisianos , 2006 .

[28]  P. Moriña-Vázquez,et al.  Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[29]  K. Ellenbogen,et al.  Recruitment of bundle branches with permanent His bundle pacing in a patient with advanced conduction system disease: What is the mechanism? , 2016, Heart rhythm.

[30]  K. Ellenbogen,et al.  Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. , 2015, Heart rhythm.

[31]  Daniel D. Correa de Sa,et al.  Autopsy analysis of the implantation site of a permanent selective direct his bundle pacing lead. , 2012, Circulation. Arrhythmia and electrophysiology.

[32]  O. Ajijola,et al.  Physiological mechanisms of QRS narrowing in bundle branch block patients undergoing permanent His bundle pacing. , 2016, Journal of electrocardiology.

[33]  Amrish Deshmukh,et al.  His bundle pacing: Initial experience and lessons learned. , 2016, Journal of electrocardiology.