Development of New-Onset or Progressive Atrial Fibrillation in Patients With Permanent HIS Bundle Pacing Versus Right Ventricular Pacing: Results From the RUSH HBP Registry

J Am Heart Assoc. 2020 Nov 17;9(22):e018478. doi: 10.1161/JAHA.120.018478. Epub 2020 Nov 11.


Background Conventional right ventricular pacing (RVP) has been associated with an increased incidence of atrial fibrillation (AF). We sought to compare the occurrence of new-onset AF and assessed AF disease progression during long-term follow-up between His bundle pacing (HBP) and RVP. Methods and Results We included patients undergoing initial dual-chamber pacemaker implants at Rush University Medical Center between January 1, 2016, and June 30, 2019. A total of 360 patients were evaluated, and 225 patients (HBP, n=105; RVP, n=120) were included in the study. Among the 148 patients (HBP, n=72; RVP, n=76) with no history of AF, HBP demonstrated a lower risk of new-onset AF (adjusted hazard ratio [HR], 0.53; 95% CI, 0.28-0.99; P=0.046) compared with traditional RVP. This benefit was observed with His or RVP burden exceeding 20% (HR, 0.29; 95% CI, 0.13-0.64; P=0.002), ≥40% (HR, 0.31; P=0.007), ≥60% (HR, 0.35; P=0.015), and ≥80% (HR, 0.40; P=0.038). There was no difference with His or RV pacing burden <20% (HR, 0.613; 95% CI, 0.213-1.864; P=0.404). In patients with a prior history of AF, there was no difference in AF progression (P=0.715); however, in a subgroup of patients with a pacing burden ≥40%, HBP demonstrated a trend toward a lower risk of AF progression (HR, 0.19; 95% CI, 0.03-1.16; P=0.072). Conclusions HBP demonstrated a lower risk of new-onset AF compared with RVP, which was primarily observed at a higher pacing burden.

Keywords: Atrial fibrillation; atrial fibrillation progression; his bundle pacing; new‐onset atrial fibrillation; right ventricular pacing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / prevention & control*
  • Bundle of His*
  • Cardiac Pacing, Artificial*
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pacemaker, Artificial*
  • Registries
  • Retrospective Studies
  • Stroke Volume