Permanent parahisian pacing is feasible, effective and more physiologic: no more right ventricular apical pacing and no compulsive need for elaborate His bundle pacing

Right ventricular apical or outflow-tract pacing is non-physiological, conferring longterm deleterious effects; His-bundle (HB) pacing (HBP) is more physiologic but elaborate requiring extra tools.Parahisian pacing (PHP), adopted by us for ~20 years, is an effective/ practical option, with the pacing lead placed near the HB or the proximal right bundle branch guided by fluoroscopy and electrocardiography, seeking a narrow-paced QRS by actively fixing the electrode across the tricuspid valve, against its septal leaflet.Comparative trials report that nonselective and selective HBP appear comparable regarding left-ventricular function, death or hospitalization.More comparative data with other pacing approaches are needed before PHP is widely adopted.