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His bundle pacing (HBP) represents a physiological pacing strategy for patients with first-degree atrioventricular (AV) block and narrow QRS, allowing PR interval normalization while maintaining native ventricular activation. In this case, conduction system pacing (CSP) was chosen to prevent pacing-induced dyssynchrony in a patient with prolonged AV conduction and an expected high pacing burden. Initial attempts using a lumenless lead (LLL) failed due to fibrotic tissue at the His region, but switching to a stylet-driven lead (SDL) enabled stable fixation and non-selective His capture with excellent electrical parameters. The case highlights how tools choice can determine procedural success and demonstrates that HBP remains the most physiological option for restoring AV synchrony in patients with significant conduction delay.

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His Bundle Pacing in First-Degree AV Block and Narrow QRS

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  • 发表日期：

    2026年

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  • Giorgio Porcelli

摘要

His bundle pacing (HBP) represents a physiological pacing strategy for patients with first-degree atrioventricular (AV) block and narrow QRS, allowing PR interval normalization while maintaining native ventricular activation. In this case, conduction system pacing (CSP) was chosen to prevent pacing-induced dyssynchrony in a patient with prolonged AV conduction and an expected high pacing burden. Initial attempts using a lumenless lead (LLL) failed due to fibrotic tissue at the His region, but switching to a stylet-driven lead (SDL) enabled stable fixation and non-selective His capture with excellent electrical parameters. The case highlights how tools choice can determine procedural success and demonstrates that HBP remains the most physiological option for restoring AV synchrony in patients with significant conduction delay.