His Bundle pacing

This is a really funny name.

It makes no sense to anyone except Cardiologists who remember that there was a person who identified a bundle of specialised conduction tissue within the heart.  That person was Wilhelm His Jr, hence the name “Bundle of His”.

It is pronounced Hiss rather than Hiz, by the way.

So what’s all the excitement about?

Well the Bundle of His is part of the normal wiring system of the heart and is responsible for carrying signals from the atrioventricular node down to the ventricles.

We have learnt that even in patients whose atrioventricular node doesn’t work properly, we are able to pace the Bundle of His and stimulate the ventricles via the rest of the normal wiring system.  This looks very pretty on an ECG!

This has been very challenging to do in the past, but newer techniques have made it more feasible.

Observational data from 765 patients in the USA has demonstrated that this is a safe and feasible technique, and suggests that it reduces the combination of death, heart failure or an upgrade to a more complex pacemaker.

This is only observational data, but there is growing evidence to suggest it might be better and worth a proper randomised study.

I’m pleased to be offering His bundle pacing to my ICD patients as part of the Hope-HF study for which I’m a Principal Investigator.  This is a study coordinated by Imperial College, London and I performed the first His bundle pacing in Medway last year.  It’s too early to know if it’s helpful in that population, but I’m sure we will see more interest in the pacemaker population in the coming years

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