Permanent HIS bundle pacing – a valid alternative to biventricular cardiac resynchronization therapy?

Cardiac resynchronisation therapy (CRT) using biventricular pacing has become standard of care for patients with symptomatic heart failure, wide QRS and left ventricular ejection fraction (LVEF) <35% refractory to optimal medical treatment. Convincing data have demonstrated improvement in quality life as well mortality rates CRT responders. However, individual long-term response is difficult predict by the usual 25–30% rate non-response.