Author + information
- Pugazhendhi Vijayaraman, MD∗ ( )( and )
- Jess W. Oren, MD
- ↵∗Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711
We thank Drs. Scherlag and Elkholey for their interest in our study (1). Right ventricular endocardial pacing has been the standard ventricular pacing site for >5 decades. Even though Wiggers (2) reported on the physiological observations identifying the abnormal ventricular function resulting from focal ventricular stimulation as early as in 1925, it was not until recently that the deleterious effects of right ventricular pacing were fully recognized. Biventricular pacing overcame some of the ill effects of right ventricular pacing, but does not replicate activation of the ventricles by the His Purkinje system. His bundle pacing offers an opportunity to achieve the most effective means to excite the ventricles (3).
The findings of our study (1) support the feasibility and safety of His bundle pacing and the clinical benefit in the form of decreased mortality, heart failure hospitalizations, and upgrade to biventricular pacing in patients requiring ventricular pacing. Recently, other investigators have also demonstrated the feasibility and the benefits of His bundle pacing in patients requiring cardiac resynchronization therapy (4,5).
The development of implantation techniques and the tools necessary to achieve successful implantation will continue to evolve. Current limitations include the limited ability to train operators, the lack of optimal technology necessary to effectively deliver His bundle pacing, the inability to consistently overcome the effects of significant infra-Hisian conduction disease, anatomical constraints, and the effects of increased energy requirements for His bundle pacing.
His bundle pacing remains an emerging technology with significant promise for the future. Randomized clinical trials are necessary to define the utility and role of His bundle pacing. With this clinical data (1) and the support from our colleagues in the medical device industry to develop the necessary technology, His bundle pacing is likely to become the preferred ventricular pacing site of the future.
Please note: Dr. Vijayaraman has served as a speaker for and received research support from Medtronic; has served as a consultant for Boston Scientific, Abbott, and Medtronic; and has a patent pending for a His delivery tool. Dr. Oren has received research support from Medtronic.
- 2018 American College of Cardiology Foundation
- Abdelrahman M.,
- Subzposh F.A.,
- Beer D.,
- et al.
- Wiggers C.
- Sharma P.S.,
- Dandamudi G.,
- Herweg B.,
- et al.