Introduction: Long term right ventricular pacing has been associated with an increased risk of heart failure development due to pacing induced cardiomyopathy. Therefore, several alternatives of more physiologi-cal pacing have been evaluated. Amongst them, His bundle pacing (HBP) has emerged in the past decade as the most physiological method of ventricular pacing due to synchronous activation of both ventricles throu-gh the intrinsic conduction system. We present our initial experience after implemen-ting His bundle pacing in our service.

Methods: Between July 2018 and May 2019, HBP using the current available dedicated delivery system was attempted in 28 patients with permanent pacing indi-cations. Patient characteristics and procedural results were analyzed during implant and at 3 and 6 months follow-up.

Results: The acute procedural success (either selective or nonselective His bundle capture) was achieved in 25 patients (89%). Selective His bundle pacing was seen in 12 out of 25 patients with nonselective His bundle pacing in the rest. The acute His pacing threshold was 1.77 ± 1.20 V at 1 ms, the sensed R wave amplitude was 4.55 ± 2.93 mV and total fluoroscopy time was 20.64 ± 10.45 min. The paced QRS duration was similar to the baseline QRS in patients without bundle branch and narrower in patients with bundle branch morphology. The presence of a native QRS complex with a bundle branch block morphology was associated with an in-creased risk of procedural failure, longer fluoroscopy times and higher capture thresholds. 16 patients rea-ched the 3 months follow-up and 10 patients reached the 6 months follow-up. There was only one significant increase in His pacing threshold at 6 months which was resolved by device reprogramming. No lead dislodgements were encountered.

Conclusions: His bundle pacing is feasible and easy to implement in an experienced device implantation cen-ter with a high procedural success rate. Proper patient selection could influence the outcomes of the procedu-re.