His Bundle Pacing

ACC's Electrophysiology Council

Research output: Contribution to journalReview articlepeer-review

162 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)927-947
Number of pages21
JournalJournal of the American College of Cardiology
Issue number8
StatePublished - Aug 21 2018


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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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