| Sumario: | Background: His‐Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. Methods: We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. Results: A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV‐FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31–37) vs. RVP 33 IQR (29.7–37.2),p =.602; 6‐months: HBP 37 IQR (33–39) vs. RVP 30 IQR (27.7–35), p <.0001] and RV‐GLS (Global Longitudinal Strain)% [baseline: HBP –18 IQR (–20.2 to –15) vs. RVP –16 IQR (–18.7 to –14), p =.150; 6‐months: HBP –20 IQR(–23 to –17) vs. RVP –13.5 IQR (–16 to –11), p <.0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p <.0001) and S wave velocity (p <.0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32–42) mmHg vs. RVP 34 IQR (31.5–37) mmHg,p =.060; 6‐months: HBP 32 IQR (26–38) mmHg vs. RVP 39 IQR (36–41) mmHg, p <.0001] and tricuspid regurgitation (p =.005) irrespectively from lead position above or below the tricuspid valve. Conclusions: In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.
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