Prognostic benefits of His‐Purkinje capture in physiological pacemakers for bradycardia

Introduction Clinical outcomes of long‐term ventricular septal pacing (VSP) without His‐Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP). Methods Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)‐hospitalizations and all‐cause mortality at 2 years. VSP was defined as septal pacing due to unsuccessful CSP implant or successful CSP followed by loss of His‐Purkinje capture within 90 days. Results Among 1016 patients (age 73.9 ± 11.2 years, 47% female, 48% atrioventricular block), 612 received RVP, 335 received CSP and 69 received VSP. Paced QRS duration was similar between VSP and RVP, but both significantly longer than CSP (p 20%, or amongst groups with Vp