Do we need to pace the bundle? Editorial comment on: Nonselective versus selective His bundle pacing: An acute intrapatient speckle tracking strain echocardiographic study by Bednarek et al.

Bednarek et al. reported that there is hardly any difference in echocardiographically-measured ventricular function between selective (s-HBP) and non selective His bundle pacing (ns-HBP). Important is to realize that echocardiographic measurements were made after 5 minutes of pacing at each pacing modes, which is likely a too short interval to predict long term clinical differences between s-HBP and ns-HBP. On the other hand, even less optimal pacing modes, like left bundle branch and left ventricular septum pacing have been proven to preserve left ventricular function. Therefore the Bednarek data do seem to fit in the bigger picture that positioning the pacing electrode inside the His bundle may not be required for preservation of normal function. This article is protected by copyright. All rights reserved.