Selective versus non-selective his bundle pacing for cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) has an established role in the device-based therapy for patients with systolic dysfunction and intraventricular conduction delay, particularly left bundle branch block (LBBB). Recently, His bundle pacing (HBP) has emerged as a viable alternative for resynchronization which can successfully narrow surface QRS and improve mechanical dyssynchrony. The role of selective (i.e., an isoelectric His-paced to QRS interval similar to native HV interval) versus non-selective capture (i.e., engagement of His along with adjacent local myocardial tissue and pseudo-delta wave) and outcome after HBP for resynchronization is not clear. In this article, we review the current literature (case reports and case series) reporting on HBP for resynchronization and comment on favorable predictors of response.