His-bundle pacing is the best approach to physiological pacing

doi:10.1016/j.hroo.2020.03.001

. 2020 Apr 27;1(1):68-75.

doi: 10.1016/j.hroo.2020.03.001. eCollection 2020 Apr.

His-bundle pacing is the best approach to physiological pacing

Gaurav A Upadhyay¹, Pouyan Razminia¹, Roderick Tung¹

Affiliations

PMID: 34113860
PMCID: PMC8183870
DOI: 10.1016/j.hroo.2020.03.001

His-bundle pacing is the best approach to physiological pacing

Gaurav A Upadhyay et al. Heart Rhythm O2. 2020.

. 2020 Apr 27;1(1):68-75.

doi: 10.1016/j.hroo.2020.03.001. eCollection 2020 Apr.

Authors

Gaurav A Upadhyay¹, Pouyan Razminia¹, Roderick Tung¹

Affiliation

¹ The University of Chicago Medicine, Center for Arrhythmia Care, Heart and Vascular Center, Chicago, Illinois.

PMID: 34113860
PMCID: PMC8183870
DOI: 10.1016/j.hroo.2020.03.001

No abstract available

Keywords: Biventricular pacing; Cardiac resynchronization therapy; His-bundle pacing; Left bundle branch block; Pacemaker; Right bundle branch block.

PubMed Disclaimer

Figures

**Figure 1**
Complete correction of wide QRS (**top:** left bundle branch block) with His-bundle pacing (HBP), restoring physiological conduction through intrinsic activation of the His–Purkinje system (**bottom:** corrected HBP).

**Figure 2**
Subtle differences in surface QRS morphology with LCS and LVS. Both exhibit an isoelectric segment after the stimulus; however, intracardiac recordings show evidence of septal capture. High-density mapping of the septum shows presystolic recruitment of Purkinje, which proves LCS, whereas passive Purkinje is still activated at QRS onset during LVS. No data suggest whether these responses are equivalent. LCS = left conduction system; LVAT = left ventricular activation time; LVS = left ventricular (LV) septum.

**Figure 3**
Evidence of intraseptal substrate that impedes the ability to fix the lead deeper and correct wide QRS. Unipolar electrogram shows significant fractionated local recording within the septum. Without including the S-QRS, the left ventricular activation time (LVAT) is already 84 ms from intrinsicoid deflection, signifying inability to achieve cardiac resynchronization therapy by left bundle branch area pacing.

See this image and copyright information in PMC

Cited by

Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application.
Nguyên UC, Rijks JHJ, Plesinger F, Rademakers LM, Luermans J, Smits KC, van Stipdonk AMW, Prinzen FW, Vernooy K, Halamek J, Curila K, Jurak P. Nguyên UC, et al. J Cardiovasc Dev Dis. 2024 Feb 23;11(3):76. doi: 10.3390/jcdd11030076. J Cardiovasc Dev Dis. 2024. PMID: 38535099 Free PMC article. Review.
Comparative analysis of left bundle branch area pacing in patients with and without a history of open-heart surgery.
Nohno Y, Kozu R, Ito K, Chikazawa Y, Maruyama S, Hasegawa T, Tsuchiya H, Tachibana T, Kimura H, Yazaki Y. Nohno Y, et al. J Arrhythm. 2025 Jan 30;41(1):e70010. doi: 10.1002/joa3.70010. eCollection 2025 Feb. J Arrhythm. 2025. PMID: 39886037 Free PMC article.
State of the Journal 2021: Heart Rhythm O ².
Poole JE. Poole JE. Heart Rhythm O2. 2021 Feb 19;2(1):1-2. doi: 10.1016/j.hroo.2021.01.003. eCollection 2021 Feb. Heart Rhythm O2. 2021. PMID: 34113897 Free PMC article. No abstract available.
Gender Differences for His Bundle Pacing Long-Term Performance in the Elderly Population.
Pestrea C, Cicala E, Lovin D, Gheorghe A, Ortan F, Manea R. Pestrea C, et al. J Cardiovasc Dev Dis. 2025 Feb 26;12(3):88. doi: 10.3390/jcdd12030088. J Cardiovasc Dev Dis. 2025. PMID: 40137086 Free PMC article.
Left bundle branch pacing with and without anodal capture: impact on ventricular activation pattern and acute haemodynamics.
Ali N, Saqi K, Arnold AD, Miyazawa AA, Keene D, Chow JJ, Little I, Peters NS, Kanagaratnam P, Qureshi N, Ng FS, Linton NWF, Lefroy DC, Francis DP, Boon Lim P, Tanner MA, Muthumala A, Agarwal G, Shun-Shin MJ, Cole GD, Whinnett ZI. Ali N, et al. Europace. 2023 Oct 5;25(10):euad264. doi: 10.1093/europace/euad264. Europace. 2023. PMID: 37815462 Free PMC article.

See all "Cited by" articles

References

1. Durrer D., van Dam R.T., Freud G.E., Janse M.J., Meijler F.L., Arzbaecher R.C. Total excitation of the isolated human heart. Circulation. 1970;41:899–912. - PubMed
1. Keene D., Arnold A.D., Jastrzebski M. His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: insights from a large international observational study. J Cardiovasc Electrophysiol. 2019;30:1984–1993. - PMC - PubMed
1. Kim J., Goldbarg S., Leung S., Yang H., Slotwiner D. Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone. HeartRhythm Case Rep. 2019;5:112–114. - PMC - PubMed
1. Huang W., Su L., Wu S. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017;33:1736 e1731–1736 e1733. - PubMed
1. Zhang S., Zhou X., Gold M.R. Left bundle branch pacing: JACC review topic of the week. J Am Coll Cardiol. 2019;74:3039–3049. - PubMed

LinkOut - more resources

Full Text Sources

[1] Durrer D., van Dam R.T., Freud G.E., Janse M.J., Meijler F.L., Arzbaecher R.C. Total excitation of the isolated human heart. Circulation. 1970;41:899–912. - PubMed

[2] Durrer D., van Dam R.T., Freud G.E., Janse M.J., Meijler F.L., Arzbaecher R.C. Total excitation of the isolated human heart. Circulation. 1970;41:899–912. - PubMed

[3] Keene D., Arnold A.D., Jastrzebski M. His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: insights from a large international observational study. J Cardiovasc Electrophysiol. 2019;30:1984–1993. - PMC - PubMed

[4] Keene D., Arnold A.D., Jastrzebski M. His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: insights from a large international observational study. J Cardiovasc Electrophysiol. 2019;30:1984–1993. - PMC - PubMed

[5] Kim J., Goldbarg S., Leung S., Yang H., Slotwiner D. Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone. HeartRhythm Case Rep. 2019;5:112–114. - PMC - PubMed

[6] Kim J., Goldbarg S., Leung S., Yang H., Slotwiner D. Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone. HeartRhythm Case Rep. 2019;5:112–114. - PMC - PubMed

[7] Huang W., Su L., Wu S. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017;33:1736 e1731–1736 e1733. - PubMed

[8] Huang W., Su L., Wu S. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017;33:1736 e1731–1736 e1733. - PubMed

[9] Zhang S., Zhou X., Gold M.R. Left bundle branch pacing: JACC review topic of the week. J Am Coll Cardiol. 2019;74:3039–3049. - PubMed

[10] Zhang S., Zhou X., Gold M.R. Left bundle branch pacing: JACC review topic of the week. J Am Coll Cardiol. 2019;74:3039–3049. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

His-bundle pacing is the best approach to physiological pacing

Affiliation

His-bundle pacing is the best approach to physiological pacing

Authors

Affiliation

Figures

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources