Cardiac Rhythm Management
Articles Articles 2016 October


DOI: 10.19102/icrm.2016.071006


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Dear Readers,

Many studies have demonstrated that right ventricular pacing is associated with ventricular dyssynchrony, left ventricular systolic dysfunction, and heart failure. Biventricular pacing was introduced to answer some these concerns and was shown to result in significant gains in some patients. However, not all patients respond to this modality of pacing and others are not candidates for it. In addition, biventricular pacing can be detrimental in some groups of patients such as those with narrow QRS duration.

Permanent His bundle pacing has been performed for over 15 years ago with the aim of taking advantage of the cardiac intrinsic conduction system and preserving physiologic synchrony. However, its adoption remained relatively slow because of the perceived difficulties with this approach. These include the occasional challenges with mapping the His bundle and the lack of consistent His bundle capture. Over the past few years, the interest in His bundle was renewed and the procedural success using a 4 Fr specialized pacing lead has been high. Some centers are successfully performing permanent His bundle pacing without a mapping catheter or a backup right ventricular lead in a large percentage of patients. Moreover, comparison studies between His bundle pacing and biventricular pacing demonstrated an equivalent response between these two modalities pacing.

This issue of the Journal contains an interesting article entitled “Acute His Bundle Injury during Permanent His Bundle Pacing: Mechanistic Insights into Intra-Hisian Block”. The authors described different patterns of injury to the conduction system observed during His bundle pacing and attempted to provide mechanistic insights into the pathology of bundle branch block and intra-Hisian atrioventricular block. More importantly the authors provided explanations for the lack of His bundle capture in some cases, and shared valuable technical suggestions that may help improve the success of the procedure and reduce adverse events such as complete heart block.

I hope that you enjoy reading this issue of the Journal and that you find the content helpful for your practices.


Moussa Mansour, MD, FHRS, FACC
The Journal of Innovations in Cardiac Rhythm Management
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital
Boston, MA