Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing.

Background: His bundle pacing (HBP) can be achieved in 2 ways: selective HBP (S-HBP), where the His bundle is captured alone, and nonselective HBP (NS-HBP), where local myocardium is also captured, resulting a pre-excited electrocardiogram appearance.

Objective: We assessed the impact of this ventricular pre-excitation on left and right ventricular dyssynchrony.

Methods: We recruited patients who displayed both S-HBP and NS-HBP. We performed noninvasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern.

Results: Twenty patients were recruited. In the primary analysis, the mean within-patient change in LVAT from S-HBP to NS-HBP was -5.5 ms (95% confidence interval: -0.6 to -10.4, noninferiority < .0001). NS-HBP did not prolong RVAT (4.3 ms, -4.0 to 12.8, = .296) but did prolong QRS duration (QRSd, 22.1 ms, 11.8 to 32.4, = .0003). In patients with narrow intrinsic QRS (n = 6), NS-HBP preserved LVAT (-2.9 ms, -9.7 to 4.0, = .331) but prolonged QRS duration (31.4 ms, 22.0 to 40.7, = .0003) and mean RVAT (16.8 ms, -5.3 to 38.9, = .108) compared to S-HBP. Activation pattern of the left ventricular surface was unchanged between S-HBP and NS-HBP, but NS-HBP produced early basal right ventricular activation that was not seen in S-HBP.

Conclusion: Compared to S-HBP, local myocardial capture during NS-HBP produces pre-excitation of the basal right ventricle resulting in QRS duration prolongation. However, NS-HBP preserves the left ventricular activation time and pattern of S-HBP. Left ventricular dyssynchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients.