For patients with heart failure, cardiac conduction system disease (e.g. atrioventricular block), or atrial fibrillation, a pacemaker therapy may be indicated. In addition to established ventricular pacing systems, such as right ventricular or biventricular pacing, there is a new type of pacemakers called physiological pacing systems. Stimulation of the His bundle (His bundle pacing) can be classified as a physiological pacing system. His bundle pacing is intended to improve cardiac function and resynchronisation by stimulating only a single site.

This evidence synthesis included four studies (4 RCTs and 1 cohort study). In the RCTs, a total of 163 patients were included, the cohort study included 765 patients. The study duration of the included studies ranged from six months to two years. The overall quality of the available evidence on effectiveness and safety was rated as very low (GRADE rating). For only one of the indications (heart failure), randomised trials were available. Compared with right ventricular pacing, there is evidence suggesting His bundle pacing may achieve better outcomes in certain conditions. In contrast, compared with biventricular pacing, the results were insufficient to demonstrate a benefit.

Given the available evidence, results from ongoing studies should be awaited. The inclusion in the benefit catalogue is currently not recommended.