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Can His bundle pacing prevent right ventricular pacing-induced cardiomyopathy, heart failure, or death?

Right ventricular (RV) pacing (RVP) with the lead positioned in the apex is the current standard when ventricular pacing is indicated for bradycardia. However, frequent RV apical pacing is associated with an increased risk of atrial fibrillation, heart failure hospitalization (HFH), or death (1,2). RV apical pacing causes non-physiologic propagation of electrical wave fronts through the ventricles outside of the His-Purkinje conduction system and a wide QRS complex pattern. This abnormal electrical activation pattern as well as the resulting inter and intra-ventricular mechanical dyssynchrony may underlie the observed adverse clinical outcomes associated with RV apical pacing such as the development of RVP induced cardiomyopathy or heart failure (3).