Skip to main content

Value of surface electrocardiography in His bundle pacing

Bedeutung des Oberflächenelektrokardiogramms im Rahmen der His-Bündel-Stimulation


His bundle pacing (HBP) provides physiological ventricular activation and is frequently used to treat patients with bradyarrhythmias. HBP reduces the risk of developing heart failure and atrial fibrillation by preventing ventricular electromechanical dyssynchrony associated with conventional right ventricular pacing. There are two types of HBP, including selective (S-HBP) and non-selective HBP (NS-HBP). It is important to determine the type of HBP during implantation and follow-up. This review discusses the role of standard surface electrocardiography in differentiating S‑HBP and NS-HBP and diagnosing loss of His bundle capture.


Die His-Bündel-Stimulation (HBS) ermöglicht eine physiologische Ventrikelaktivierung und wird häufig bei Bradykardien eingesetzt. Die HBS senkt das Risiko der Entwicklung von Herzinsuffizienz und Vorhofflimmern durch Verhinderung einer ventrikulären elektromechanischen Dyssynchronie, die mit der üblichen rechtsventrikulären Stimulation assoziiert ist. Es gibt zwei Formen der HBS: die selektive (S-HBS) und die nichtselektive (NS-HBS). Wichtig ist die Bestimmung der HBS-Form bei Implantation und in der Nachverfolgung. In der vorliegenden Übersichtsarbeit wird die Rolle des Standardoberflächenelektrokardiogramms in der Unterscheidung zwischen S‑HBS und NS-HBS sowie in der Diagnostik eines Verlusts der His-Bündel-Erfassung erörtert.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Sweeney MO, Hellkamp AS, Ellenbogen KA et al (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107(23):2932–2937

    Article  Google Scholar 

  2. 2.

    Sharma PS, Dandamudi G, Naperkowski A et al (2015) Permanent his-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm 12(2):305–312

    Article  Google Scholar 

  3. 3.

    Abdelrahman M, Subzposh FA, Beer D et al (2018) Clinical outcomes of his bundle pacing compared to right ventricular pacing. J Am Coll Cardiol 71(20):2319–2330

    Article  Google Scholar 

  4. 4.

    Deshmukh P, Casavant DA, Romanyshyn M et al (2000) Permanent, direct his-bundle pacing: a novel approach to cardiac pacing in patients with normal his-Purkinje activation. Circulation 101(8):869–877

    CAS  Article  Google Scholar 

  5. 5.

    Vijayaraman P, Ellenbogen KA (2018) Approach to permanent his bundle pacing in challenging implants. Heart Rhythm 15(9):1428–1431

    Article  Google Scholar 

  6. 6.

    Sharma PS, Dandamudi G, Herweg B et al (2018) Permanent his-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience. Heart Rhythm 15(3):413–420

    Article  Google Scholar 

  7. 7.

    Boczar K, Sławuta A, Ząbek A et al (2019) Cardiac resynchronization therapy with his bundle pacing. Pacing Clin Electrophysiol 42(3):374–380

    Article  Google Scholar 

  8. 8.

    Jastrzębski M, Moskal P, Bednarek A et al (2018) His-bundle pacing as a standard approach in patients with permanent atrial fibrillation and bradycardia. Pacing Clin Electrophysiol 41(11):1508–1512

    Article  Google Scholar 

  9. 9.

    Vijayaraman P, Dandamudi G, Zanon F et al (2018) Permanent his bundle pacing: recommendations from a multicenter his bundle pacing collaborative working group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 15(3):460–468

    Article  Google Scholar 

  10. 10.

    Lustgarten DL, Crespo EM, Arkhipova-Jenkins I et al (2015) His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm 12(7):1548–1557

    Article  Google Scholar 

  11. 11.

    Barba-Pichardo R, Manovel Sánchez A, Fernández-Gómez JM et al (2013) Ventricular resynchronization therapy by direct his-bundle pacing using an internal cardioverter defibrillator. Europace 15(1):83–88

    Article  Google Scholar 

  12. 12.

    Upadhyay GA, Vijayaraman P, Nayak HM et al (2019) On-treatment comparison between corrective his bundle pacing and biventricular pacing for cardiac resynchronization: a secondary analysis of the his-SYNC pilot trial. Heart Rhythm 16(12):1797–1807

    Article  Google Scholar 

  13. 13.

    Sharma PS, Huizar J, Ellenbogen KA et al (2016) Recruitment of bundle branches with permanent his bundle pacing in a patient with advanced conduction system disease: what is the mechanism? Heart Rhythm 13(2):623–625

    Article  Google Scholar 

  14. 14.

    Jastrzębski M, Moskal P, Curila K et al (2019) Electrocardiographic characterization of non-selective his-bundle pacing: validation of novel diagnostic criteria. Europace 21(12):1857–1864

    Article  Google Scholar 

  15. 15.

    Khurshid S, Epstein AE, Verdino RJ et al (2014) Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm 11(9):1619–1625

    Article  Google Scholar 

  16. 16.

    Kiehl EL, Makki T, Kumar R et al (2016) Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm 13(12):2272–2278

    Article  Google Scholar 

  17. 17.

    Sharma PS, Vijayaraman P, Ellenbogen KA (2020) Permanent his bundle pacing: shaping the future of physiological ventricular pacing. Nat Rev Cardiol 17(1):22–36.

    Article  PubMed  Google Scholar 

  18. 18.

    Curila K, Prochazkova R, Jurak P et al (2020) Both selective and nonselective his bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECG. Heart Rhythm 17(4):607–614.

    Article  PubMed  Google Scholar 

  19. 19.

    Zhang J, Guo J, Hou X et al (2018) Comparison of the effects of selective and non-selective his bundle pacing on cardiac electrical and mechanical synchrony. Europace 20(6):1010–1017

    Article  Google Scholar 

  20. 20.

    Beer D, Sharma PS, Subzposh FA et al (2019) Clinical outcomes of selective versus nonselective his bundle pacing. JACC Clin Electrophysiol 5(7):766–774

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Adrian Baranchuk MD FACC FRCPC FCCS.

Ethics declarations

Conflict of interest

G. Çinier, G. Bazoukis, B. Alexander, C.W. Israel and A. Baranchuk declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Çinier, G., Bazoukis, G., Alexander, B. et al. Value of surface electrocardiography in His bundle pacing. Herzschr Elektrophys 31, 144–150 (2020).

Download citation


  • Bradyarrhythmias
  • Ventricular activation
  • Ventricular electromechanical dyssynchrony
  • Atrial fibrillation
  • Heart failure


  • Bradykardie
  • Ventrikelaktivierung
  • Ventrikuläre elektromechanische Dyssynchronie
  • Vorhofflimmern
  • Herzinsuffizienz