His bundle pacing: Initial experience and lessons learned

• A century of physiologic and clinical investigations have demonstrated the benefits of preserving the normal rapid multisite coordinated activation of the ventricles as determined by the His-Purkinje activating system.
• Permanent direct His bundle pacing is well defined by electrophysiologic criteria.
• Since the initial experience, permanent His bundle pacing has become recognized as an optimal pacing mode in patients both with preserved and diseased His-Purkinje activating systems.

Direct His bundle pacing provides the most physiologic means of artificial pacing of the ventricles with a preserved His-Purkinje system and may play a role in patients with a diseased intrinsic conduction system. We describe our initial motivations and experience with permanent direct His bundle pacing and important lessons learned since that time.