CVM Cardiovascular Medicine 1664-204X 1664-2031 EMH Schweizerischer Ärzteverlag AG Farnsburgerstrasse 8 CH-4132 Muttenz 02188 10.4414/cvm.2022.02188 Case report Arrhythmias Permanent HIS bundle pacing – a valid alternative to biventricular cardiac resynchronization therapy? Hilfiker Gabriela gabi.hilfiker@bluewin.ch BELGIUM 01 03 2022 25 02 0 0 Copyright: EMH Schweizerischer Ärzteverlag AG 2022 EMH Schweizerischer Ärzteverlag AG "Cardiovascular Medicine" is an open access publication of EMH published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International. You are free to share, copy and redistribute the material in any medium or format under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. "Non-commercial" means not primarily intended for or directed towards commercial advantage or monetary compensation. The incorporation of publications in commercial products, the use of publications to advertise for commercial products or services and any other usage that directly or indirectly pursues commercial interests is subject to the express previous consent of the publishing house as part of a written agreement. Please send us your request in writing. Exact indication of the publication from which you would like to reproduce material and detailed information about its intended use help to facilitate and expedite request processing.

Summary Cardiac resynchronization therapy (CRT) using biventricular pacing has become standard of care therapy for patients with symptomatic heart failure, wide QRS and left ventricular ejection fraction (LV-EF) < 35% refractory to optimal medical treatment. Tremendous data has demonstrated improvement in quality of life as well as mortality rates in CRT responders. However individual long-term response is difficult to predict as demonstrated by the usual 25-30% rate of non-responders. Permanent His bundle pacing (HBP) has emerged as an alternative to biventricular pacing to deliver physiologic pacing as well as cardiac resynchronization. We are presenting the case of a 78-year-old patient in whom resynchronization using His bundle pacing translated into a clearly superior acute electrical result compared to biventricular pacing.