His Bundle Pacing Or Biventricular Pacing For Cardiac Resynchronization Therapy In Heart Failure: Discovering New Methods For An Old Problem.

Heart failure (HF) is one of the biggest epidemics of modern cardiovascular medicine. Cardiac resynchronization therapy (CRT) with biventricular (BiV) pacing has proven to have an integral role in the management of patients with reduced left ventricular (LV) function and left bundle branch blocks (LBBB). However, CRT with BiV pacing is not always feasible and even when it is, the percentage of non-responders remains high. Limitations in LV lead implantation due to anatomical or other constraints; non response to BiV pacing due to lead position or patient related factors and lack of benefit in patients with RBBB and patients with AV block and low normal LV function limit the use of BiV pacing. Permanent His Bundle pacing (HBP) is now a feasible alternative to BiV pacing for CRT therapy. This allows for recruitment of BBB disease and ventricular activation in a more physiological fashion. In this paper we review the physiology of HBP, available data on HBP for CRT and highlight how HBP can be a potential alternative in patients in whom BiV pacing did not provide clinical response or was unsuccessful.