His-Bündel-Stimulation und konventionelle Herzschrittmachertherapie: Klinische Evaluation eines neuen, physiologischen Stimulationsverfahrens
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Abstract
Background: His-bundle pacing (HBP) enables physiological cardiac conduction and
thus represents a promising alternative to conventional right ventricular (RV) pacing
for the treatment of bradyarrhythmias. The aim of this study was to compare
procedural parameters and clinical outcomes of the two pacing modalities in routine
clinical practice.
Methods: A retrospective, single-center cohort analysis was conducted. A total of 484
patients who underwent implantation of a conventional CIED between 2017 and 2019
at the Department of Cardiology, University Hospital Gießen and Marburg (UKGM),
Marburg, were included. This cohort was compared with 82 patients who received an
HBP-based CIED implantation between 2018 and 2020 at the same institution. Clinical
baseline characteristics, procedural parameters, and electrical lead measurements were
assessed at implantation and during short- and long-term follow-up. Additionally,
hospitalization and mortality rates were analyzed in both groups.
Results: A total of 566 patients were included (mean age 75 ± 11.3 years; 62.2% male).
The HBP group demonstrated a higher prevalence of ischemic cardiomyopathy, atrial
fibrillation, chronic kidney disease, and elevated NT-proBNP levels, and more
frequently presented with tricuspid regurgitation. Left ventricular ejection fraction and
NYHA class distribution were comparable between groups.
Procedure duration [45 min. (30– 53 min.) vs. 48,5 Min (40 – 60 min.), p < 0,01]
and fluoroscopy time [2,1 min. (1,1 - 4 min.) vs. 6,0 min. (4 – 10 min.), p < 0,01] were
slightly but significantly longer in the HBP group, while dose–area product did not
differ between groups (1002,7 ± 3411,1 cGy·cm² vs. 817,2 ± 964,2 cGy·cm², p = 0,054). The
success rate of His-lead implantation was 96%. The postoperative complication rate
was 7,2%, with 1,1% of events attributable not to the CIED implantation itself but to
concomitant tf-TAVI procedures.
The HBP group exhibited the expected higher pacing thresholds (0,5 V at 0,4 ms vs. 0,8
V at 0,4 ms, p < 0,01) and lower sensing amplitudes (12,05 mV vs. 5,3 mV, p < 0,01),consistent with anatomical and physiological properties of the His region. Both
parameters remained stable throughout long-term follow-up.
After implantation, the HBP group showed a significantly shorter QRS duration, which
persisted during follow-up (119,57 ± 28,72 ms vs. 114,69 ± 23,40 ms). In contrast, the
RVP group demonstrated an increase in QRS duration (118,90 ± 31,15 ms vs. 124,95 ±
31,76 ms) and pacing burden over time.
Overall hospitalization rates did not differ significantly, although the RVP group
showed a trend toward more hospitalizations due to heart failure, CRT upgrades, and
device-related infections. Lead revisions were more frequent in the HBP group;
however, only about half involved the His lead itself.
The mortality rate was significantly higher in the RVP group. Kaplan–Meier analysis
showed consistently higher survival probabilities in the HBP group, though without
reaching statistical significance.
Conclusion: His-bundle pacing represents a safe and effective alternative to traditional
right ventricular pacing. This study provides evidence suggesting that HBP may offer a
long-term survival benefit compared with RV pacing. By preserving a narrower QRS
duration—even at high pacing percentages—HBP may reduce the risk of pacing-
induced cardiomyopathy and heart failure–related hospitalizations. Prospective,
randomized studies with larger patient cohorts are required to confirm these findings
and strengthen the validity of the results.
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Except where otherwise noted, this item's license is described as Attribution 4.0 International