{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T13:51:45Z","timestamp":1782309105350,"version":"3.54.5"},"reference-count":47,"publisher":"Radcliffe Medical Media Ltd","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018]]},"abstract":"<jats:p>Biventricular pacing has revolutionised the treatment of heart failure in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Furthermore, biventricular pacing does not fully normalise ventricular activation and, therefore, the ventricular resynchronisation is imperfect. Right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising alternate site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it may open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the physiology, technology and potential roles of His bundle pacing in the prevention and treatment of heart failure.<\/jats:p>","DOI":"10.15420\/aer.2018.6.2","type":"journal-article","created":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T11:42:22Z","timestamp":1529581342000},"page":"103","source":"Crossref","is-referenced-by-count":51,"title":["His Bundle Pacing: A New Frontier in the Treatment of Heart Failure"],"prefix":"10.15420","volume":"7","author":[{"given":"Nadine","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Keene","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahran","family":"Arnold","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Shun-Shin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary I","family":"Whinnett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SM Afzal","family":"Sohaib","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"National Heart and Lung Institute, Imperial College London, UK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","reference":[{"key":"ref0","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1161\/01.CIR.41.1.77","article-title":"Pervenous pacing of the specialized conducting system in man: His bundle and A-V nodal stimulation","volume":"41","author":"Narula","year":"1970","unstructured":"1. Narula OS, Scherlag BJ, Samet P. Pervenous pacing of the specialized conducting system in man: His bundle and A-V nodal stimulation. Circulation 1970;41:77-87.","journal-title":"Circulation"},{"key":"ref1","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1161\/01.CIR.101.8.869","article-title":"Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation","volume":"101","author":"Deshmukh","year":"2000","unstructured":"2. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000;101:869-77.","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.hrthm.2017.10.039","article-title":"Permanent His bundle pacing: recommendations from a multi-center HBP collaborative working group for standardization of definitions, implant measurements, and follow-up","volume":"15","author":"Vijayaraman","year":"2018","unstructured":"3. Vijayaraman P, Dandamudi G, Zanon F, et al. Permanent His bundle pacing: recommendations from a multi-center HBP collaborative working group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 2018;15:460-8.","journal-title":"Heart Rhythm"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4. Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His bundle pacing: long-term lead performance and clinical outcomes. 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Effect of chronic right ventricular apical pacing on left ventricular function. Am J Cardiol 2005;95:771-3.","journal-title":"Am J Cardiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/S0195-668X(03)00199-4","article-title":"The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population","volume":"24","author":"Thackray","year":"2003","unstructured":"9. Thackray SD, Witte KK, Nikitin NP, et al. The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population. 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Kronborg MB, Poulsen SH, Mortensen PT, Nielsen JC. Left ventricular performance during para-His pacing in patients with high-grade atrioventricular block: an acute study. Europace 2012;14:841-46.","journal-title":"Europace"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1093\/europace\/euu011","article-title":"His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study","volume":"16","author":"Kronborg","year":"2014","unstructured":"20. Kronborg MB, Mortensen PT, Poulsen SH, et al. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace 2014;16:1189-96.","journal-title":"Europace"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"21. Abdelrahman M, Subzposh FA, Beer D, et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing. 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Permanent His-bundle pacing in patients with prosthetic cardiac valves. Heart Rhythm 2017;14:59-64.","journal-title":"Heart Rhythm"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.hrthm.2017.10.031","article-title":"Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50%","volume":"15","author":"Shan","year":"2018","unstructured":"24. Shan P, Su L, Zhou X, et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50%. Heart Rhythm 2018;15:405-12.","journal-title":"Heart Rhythm"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1111\/j.1540-8159.2004.00548.x","article-title":"Direct His-Bundle Pacing: present and future","volume":"27","author":"PM","year":"2004","unstructured":"25. Deshmukh PM, Romanyshyn M. Direct His-Bundle Pacing: present and future. Pacing Clin Electrophysiol 2004;27:862-70.","journal-title":"Pacing Clin Electrophysiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1016\/j.jacc.2006.01.056","article-title":"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","volume":"47","author":"Occhetta","year":"2006","unstructured":"26. Occhetta E, Bortnik M, Magnani A, 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. J Am Coll Cardiol 2006;47:1938-45.","journal-title":"J Am Coll Cardiol"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"27. Vijayaraman P, Subzposh FA, Naperkowski A. Atrioventricular node ablation and His bundle pacing. Europace 2017;19:iv10-6.","DOI":"10.1093\/europace\/eux263"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"28. Huang W, Su L, Wu S, et al. Benefits of permanent His bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction. J Am Heart Assoc 2017;6:e005309.","DOI":"10.1161\/JAHA.116.005309"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1093\/europace\/eus228","article-title":"Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator","volume":"15","author":"Barba-Pichardo","year":"2013","unstructured":"29. Barba-Pichardo R, Manovel S\u00e1nchez A, Fern\u00e1ndez-G\u00f3mez JM, et al. Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator. 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Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic His bundle. Circulation 1978;57:473-83.","journal-title":"Circulation"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1056\/NEJMoa013168","article-title":"Cardiac resynchronization in chronic heart failure","volume":"346","author":"Abraham","year":"2002","unstructured":"41. Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845-53.","journal-title":"N Engl J Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.jelectrocard.2013.05.003","article-title":"Hisian pacing restoresbcardiac function","volume":"46","author":"Wu","year":"2013","unstructured":"42. Wu G, Cai Y, Huang W, Su L. Hisian pacing restoresbcardiac function. 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N Engl J Med 2004;350:2140-50.","journal-title":"N Engl J Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1136\/hrt.2005.080721","article-title":"Haemodynamic effects of changes in atrioventricular and interventricular delay in cardiac resynchronisation therapy show a consistent pattern: analysis of shape, magnitude and relative importance of atrioventricular and interventricular delay","volume":"92","author":"Whinnett","year":"2006","unstructured":"45. Whinnett ZI, Davies JE, Willson K, et al. Haemodynamic effects of changes in atrioventricular and interventricular delay in cardiac resynchronisation therapy show a consistent pattern: analysis of shape, magnitude and relative importance of atrioventricular and interventricular delay. Heart 2006;92:1628-34.","journal-title":"Heart"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1093\/eurjhf\/hft139","article-title":"Meta-analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy","volume":"15","author":"Sohaib","year":"2013","unstructured":"46. Sohaib SM, Chen Z, Whinnett ZI, et al. Meta-analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy. Euro J Heart Fail 2013;15:1419-28.","journal-title":"Euro J Heart Fail"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/j.jacep.2015.08.008","article-title":"Atrioventricular optimized direct His bundle pacing improves acute hemodynamic function in patients with heart failure and PR interval prolongation without left bundle branch block","volume":"1","author":"Sohaib","year":"2015","unstructured":"47. Sohaib SM, Wright I, Lim E, et al. Atrioventricular optimized direct His bundle pacing improves acute hemodynamic function in patients with heart failure and PR interval prolongation without left bundle branch block. 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