Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Honorary Clinical Senior Lecturer



+44 (0)20 3313 1664m.koa-wing05




Cardiac Catheter Laboratory (EP)Hammersmith HospitalHammersmith Campus






BibTex format

author = {Arnold, A and Shun-Shin, M and Keene, D and Howard, J and Sohaib, S and wright, I and Cole, G and Qureshi, N and lefroy, D and Koa-Wing, M and Linton, N and Lim, P and Peters, N and Davies, D and muthumala, A and Tanner, M and ellenbogen, K and Kanagaratnam, P and Francis, D and Whinnett, Z},
doi = {10.1016/j.jacc.2018.09.073},
journal = {Journal of the American College of Cardiology},
pages = {3112--3122},
title = {His resynchronization versus biventricular pacing in patients with heart failure and left bundle branch block},
url = {},
volume = {72},
year = {2018}

RIS format (EndNote, RefMan)

AB - Background His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).Objectives The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.Methods Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.Results In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).Conclusions His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.
AU - Arnold,A
AU - Shun-Shin,M
AU - Keene,D
AU - Howard,J
AU - Sohaib,S
AU - wright,I
AU - Cole,G
AU - Qureshi,N
AU - lefroy,D
AU - Koa-Wing,M
AU - Linton,N
AU - Lim,P
AU - Peters,N
AU - Davies,D
AU - muthumala,A
AU - Tanner,M
AU - ellenbogen,K
AU - Kanagaratnam,P
AU - Francis,D
AU - Whinnett,Z
DO - 10.1016/j.jacc.2018.09.073
EP - 3122
PY - 2018///
SN - 0735-1097
SP - 3112
TI - His resynchronization versus biventricular pacing in patients with heart failure and left bundle branch block
T2 - Journal of the American College of Cardiology
UR -
UR -
VL - 72
ER -