Direct His bundle pacing an alternative to biventricular pacing?

Lustgarten DL et al evaluated the efficacy of direct His bundle pacing vis-a-vis biventricular pacing (Heart Rhythm 7:15-12). All the ten subjects of the study were candidates for cardiac resynchronization therapy (CRT). Direct His bundle pacing (DHBP) was temporarily implemented just prior to biventricular (BiV) pacing in those who were being taken up for cardiac resynchronization therapy. The QRS duration during native conduction, DHBP and BiV were compared. QRS duration was significantly narrower in DHBP than in native conduction or BiV in seven out ten patients (mean QRS duration: native 171 ± 13 ms, DHBP 148 ± 11 ms, BiV 158 ± 21, P <.0001). The lead implantation time was 16 minutes for DHBP while it was 42 minutes for BiV. The authors conclude that DHBP may offer a physiologic alternative to biventricular pacing for CRT.