A His bundle pacemaker is another potential option for treating symptomatic Left Bundle Branch Block (LBBB) and heart failure, and it works differently from traditional pacemakers or biventricular pacemakers.
The His bundle is part of the heart’s electrical conduction system, located near the center of the heart, and it is responsible for transmitting the electrical signal from the atria to the ventricles. A His bundle pacemaker directly stimulates this bundle to restore synchronized contraction between the atria and the ventricles.
In patients with LBBB (especially those with heart failure), the His bundle pacemaker can be particularly useful because it helps to restore natural conduction through the His-Purkinje system rather than using a device to simply stimulate the ventricles in a less synchronized manner (like a traditional pacemaker would).
Advantages of His Bundle Pacing in LBBB:
- Physiologic pacing: His bundle pacing aims to maintain normal electrical conduction and synchronization, which can lead to improved outcomes compared to other pacing options.
- Better ventricular synchrony: By stimulating the His bundle, it allows for more natural and synchronized contraction of the ventricles, which can be especially beneficial in heart failure patients.
- Lower risk of long-term pacing dependence: Unlike traditional pacemakers, His bundle pacing may reduce the need for chronic pacing, preserving more natural conduction in the heart.
However, His bundle pacing is technically more challenging than standard pacing and requires a skilled electrophysiologist. It also may not be suitable for all patients, depending on the specific characteristics of their conduction system and other underlying heart conditions.
For patients with symptomatic LBBB and heart failure, His bundle pacing can be a promising treatment, but it is typically considered after evaluating other treatment options, including biventricular pacing and medications.
Simon Downes, MD, PhD 