Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing

JACC Clin Electrophysiol. 2019 Jul;5(7):766-774. doi: 10.1016/j.jacep.2019.04.008. Epub 2019 May 10.


Objectives: The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP.

Background: HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction.

Methods: The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization.

Results: The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP.

Conclusions: NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.

Keywords: His bundle pacing; heart failure hospitalization; mortality; nonselective HBP; selective HBP.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / therapy
  • Bradycardia / therapy
  • Bundle of His / physiopathology
  • Cardiac Pacing, Artificial* / adverse effects
  • Cardiac Pacing, Artificial* / methods
  • Cardiac Pacing, Artificial* / mortality
  • Cardiac Pacing, Artificial* / statistics & numerical data
  • Female
  • Heart Failure / epidemiology
  • Heart Failure / therapy
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome