Permanent His-bundle pacemaker implantation for treating heart failure

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 5 sources, which was discussed by the committee. The evidence included 1 systematic review, 1 randomised controlled trial, 1 case control study and 2 case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: quality of life using relevant and validated measures such as the New York Heart Association classification, survival, improved cardiac function, and the need for hospital admissions.

The professional experts and the committee considered the key safety outcomes to be: cardiac perforation, cardiac arrhythmia, infection, lead breakage and lead displacement.

One commentary from a patient who has had this procedure was discussed by the committee.

The procedure may have a role in preventing pacemaker-induced cardiomyopathy, which can occur with standard right ventricle pacing techniques, and where conventional cardiac resynchronisation therapy (CRT) is clinically contraindicated or unsuccessful.

The recommendation for further research is based on the potential for this procedure to be a treatment option for heart failure.

The committee was informed that there is a trend in clinical practice towards bundle branch pacing.