His bundle pacing may have significant potential for future applications in patients who are traditional candidates for right ventricular pacing as well as cardiac resynchronization therapy, according to a council perspective from ACC's Electrophysiology Section Leadership Council published Aug. 13 in the Journal of the American College of Cardiology.

Pugazhendhi Vijayaraman, MD, FACC, et al., provide a comprehensive review of the anatomy of His bundle, early clinical observations and current approaches to permanent His bundle pacing. They note that His bundle pacing holds promise as an attractive mode to achieve physiologic pacing.

The authors explain that by stimulating the His-Purkinje network, His bundle pacing engages electrical activation of both ventricles and may avoid marked dyssynchrony. They also describe recent studies that demonstrated the potential of His bundle pacing in patients with underlying left bundle branch block and cardiomyopathy.

Furthermore, the authors note that His bundle pacing may have a theoretic advantage to conventional cardiac resynchronization therapy since it restores the intrinsic electromechanical activation sequence of the heart. They add that in some studies, patients have demonstrated improved functional status, reduced mitral regurgitation, reduced dyssynchrony, and improved left ventricular ejection fraction after His bundle pacing, on par with what has been shown in cardiac resynchronization therapy responders.

"This technique holds potential and requires further validation in larger studies with longer follow-up," the authors conclude. "It is also clear that collective and collaborative efforts from physician scientists, industry partners, scientific societies and regulatory authorities will be required to successfully develop this technology and advance our understanding of the physiology of pacing."

Keywords: Bundle-Branch Block, Bundle of His, Cardiac Resynchronization Therapy, Mitral Valve Insufficiency, Stroke Volume, Heart Ventricles, Ventricular Function, Left, Arrhythmias, Cardiac, Cardiomyopathies, Electrophysiology

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