Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7594 3381d.francis Website




Miss Juliet Holmes +44 (0)20 7594 5735




Block B Hammersmith HospitalHammersmith Campus






BibTex format

author = {Keene, D and Arnold, A and Jastrzbski, M and Burri, H and Zweibel, S and Crespo, E and Chandrasekaran, B and Bassi, S and Joghetaei, N and Swift, M and Moskal, P and Francis, D and Foley, P and Shun-Shin, M and Whinnett, Z},
doi = {10.1111/jce.14064},
journal = {Journal of Cardiovascular Electrophysiology},
pages = {1984--1993},
title = {His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study},
url = {},
volume = {30},
year = {2019}

RIS format (EndNote, RefMan)

AB - BackgroundHisbundle pacing (HBP) provides physiological ventricular activation. Observational studies have demonstrated the techniques feasibility however, data has come from a limited number of centres.ObjectivesWe set out to explore contemporary global practise in HBP focusing on learning curve, procedural characteristics and outcomes.MethodsThis is a retrospective, multicentre observational study of patients undergoing attempted HBP at seven centres. Pacing indication, fluoroscopy time, HBP thresholds and lead reintervention and deactivation rates were recorded. Where centres had systematically recorded implant success rates from the outset, these were collated.Results529 patients underwent attempted HBP during the study period (201419) with mean followup of 217±303 days. Most implants were for bradycardia indications.In the three centres with systematic collation of all attempts, overall implant success rate was 81% which improved to 87% after completion of 40 cases.All seven centres reported data on successful implants. Mean fluoroscopy time was 11.7±12.0 minutes, Hisbundle capture threshold at implant was 1.4±0.9V at 0.8±0.3 ms and was 1.3±1.2V at 0.9±0.2ms at last device check.HBP lead reintervention or deactivation (for lead displacement or rise in threshold) occurred in 7.5% of successful implants.There was evidence of a learning curve: fluoroscopy time and HBP capture threshold reduced with greater experience, plateauing after ~3050 cases.ConclusionWe found that it is feasible to establish a successful HBP program, using the currently available implantation tools. For physicians who are experienced at pacemaker implantation the steepest part of the learning curve appears to be over the first 3050 cases.
AU - Keene,D
AU - Arnold,A
AU - Jastrzbski,M
AU - Burri,H
AU - Zweibel,S
AU - Crespo,E
AU - Chandrasekaran,B
AU - Bassi,S
AU - Joghetaei,N
AU - Swift,M
AU - Moskal,P
AU - Francis,D
AU - Foley,P
AU - Shun-Shin,M
AU - Whinnett,Z
DO - 10.1111/jce.14064
EP - 1993
PY - 2019///
SN - 1045-3873
SP - 1984
TI - His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study
T2 - Journal of Cardiovascular Electrophysiology
UR -
UR -
UR -
VL - 30
ER -