AbstractIntroductionWe aimed to compare the acute differences in left ventricular (LV) function and mechanical synchrony during nonselective His bundle pacing (ns‐HBP) versus selective His bundle pacing (s‐HBP) using strain echocardiography.Methods and resultsConsecutive patients with permanent His bundle pacing, in whom it was possible to obtain both s‐HBP and ns‐HBP, were studied in two centers. In each patient, echocardiography was performed sequentially during s‐HBP and ns‐HBP. Speckle‐tracking echocardiography parameters were analyzed: Global longitudinal strain (GLS), the time delay between peak systolic strain in the basal septal and basal lateral segments (BS‐BL delay), peak strain dispersion (PSD) and strain delay index. Right ventricle function was assessed using tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of the lateral tricuspid annulus (S′).A total of 69 patients (age: 75.6 ± 10.5 years; males: 75%) were enrolled. There were no differences in LV ejection fraction and GLS between s‐HBP and ns‐HBP modes: 59% versus 60%, and −15.6% versus −15.7%, respectively; as well as no difference in BS‐BL delay and strain delay index. The PSD value was higher in the ns‐HBP group than in the s‐HBP group with the most pronounced difference in the basal LV segments. No differences in right ventricular function parameters (TAPSE and S′) were found.ConclusionThe ns‐HBP and s‐HBP modes seem comparable regarding ventricular function. The dyssynchrony parameters were significantly higher during ns‐HBP, however, the difference seems modest and clarification of its impact on LV function requires a larger long‐term study.