Letter to the Editor: His Bundle Pacing: A New Frontier in the Treatment of Heart Failure

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Correspondence Details:Theodoros Zografos, Research Associate, Athens Red Cross Hospital, 8 Artemidos Street, 16672, Vari, Athens, Greece.

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Dear Sir,

I read with great interest the elegant article by Ali et al.1 on His bundle pacing in issue 17.2 of AER. I do concur with the authors’ view and conclusions. However, there are two issues that may merit further attention.

First, specific His-bundle pacing is indeed the reasonable option that mimics the natural ventricular excitation. However, no benefit of mid-septal over apical pacing has been shown in randomised comparisons.2,3 Is this because of the relatively short-term follow-up that did not allow apical pacing to expose its deleterious effects on the ventricle or just reflects the fact that mid-septal is not equivalent to specific His pacing?

Second, acute results of His-bundle pacing are comparable to these of cardiac resynchronisation therapy (CRT).4,5 Do the authors believe that we have enough data to implement this principle in clinical practice, even before a randomised trial confirms this notion? That should have a tremendous impact on cost and efficacy of pacing in the setting of intractable heart failure, especially in view of the cost and complications of CRT, as demonstrated in the BLOCK-HF trial.6


  1. Ali N, Keene D, Arnold A, et al. His bundle pacing: a new frontier in the treatment of heart failure. Arrythm Electrophysiol Rev 2018;7:103–10.
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  2. Janousek J, van Geldorp IE, Krupicˇková S, et al. Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study. Circulation 2013;127:613–23.
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  3. Kaye GC, Linker NJ, Marwick TH, et al. Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study. Eur Heart J 2015;36:856–62.
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  4. Katritsis DG. Choice of ventricular pacing site: the end of non-physiological, apical ventricular pacing? Arrhythm Electrophysiol Rev 2017;6:159–60.
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  5. Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 2018;15:460–8.
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  6. Curtis AB, Worley SJ, Adamson PB, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013;368:1585–93.
    Crossref | PubMed