His bundle pacing, selective and non-selective: are they equally safe and effective?

Abstract Background Permanent His Bundle Pacing (HBP) is the most physiological form of ventricular pacing. bundle stimulation can be selective (s-HBP) or non-selective (ns-HBP). Few comparative data in terms safety and efficacy among two are available literature. Purpose Evaluate s-HBP ns-HBP identify predictors one other stimulation. Methods Prospective analysis patients with HBP implanted between December 2018 July 2021. The clinical instrumental parameters were collected at implant long-term follow-up. Follow-up both outpatient visits by remote monitoring systems. Results 130 need for antibradyarrhythmia therapy 26 an indication cardiac resynchronization enrolled, 134 (86%) had successful (34% 66% ns-HBP). There no significant differences populations exception presence right branch block (RBBB: 17.4% 34.1% ns-HBP; p = <0.05) baseline QRS duration (116.5±27.5 ms 129.9±34.7 <0.05). (Figure 1). At implantation average 16-month follow-up there electrical modalities. Twenty-one (15.7% population, 24% 12.5% p=0.38) conduction system disease progression, manifested either a increase pacing threshold (13.3% 10.2% recipients; p=0.64; Figure 2A) loss capture (6.5% 2.2% p=0.69). No statically progression found 2B). While seventeen who elevation underwent device output reprogramming, four patients, lost capture, single experiencing lead dislodgment (nS-HBP patient) required repositioning (8.7% 4.5% p=0.33). was significantly more vulnerable to atrial oversensing that sensitivity reprogramming (17.4% p<0.05). endpoints (cardiovascular death, heart failure, fibrillation, syncope) observed Conclusions In indicated stimulation, potential benefit represented burdened non-negligible number complications. Though detected medium-long term appears affected tissue disease, which resulted almost 2-fold (although statistically not significant) incidence repeated surgery. Funding Acknowledgement Type funding sources: None.