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Introduction:Conventional RV pacing has been associated with a small but consistent increase in tricuspid regurgitation (TR). There is a relative paucity of data on the impact of His-bundle pacing (HBP) and TR.Objective:To assess the effect of HBP on TR in patients receiving traditional single or dual-chamber and cardiac resynchronization therapy (CRT) devices.Methods:All consecutive patients implanted with HBP leads (2016-2019) were studied retrospectively at a single center. Left ventricular ejection fraction (LVEF), right ventricular (RV) function, and graded functional TR were assessed according to current ASE guidelines (Trace=1, Mild=2, Moderate=3, Severe=4). Patients were analyzed by baseline LVEF (preserved ?50% vs. reduced <50%).Results:Of 109 patients with HBP lead attempted, 68 patients with paired echocardiographic data were studied (median 5 months after implant). The overall cohort was 35% female, mean age 72?14 years, 35% CAD, 66% cardiomyopathy, and mean LVEF 42% at baseline (63% with reduced LVEF). Baseline QRS width was 137?35 ms (28% narrow QRS, 19% LBBB, 31% RBBB, 6% IVCD, 15% paced). Thirty-one patients (46%) received CRT devices. TR grade significantly improved after HBP across all patients (p=0.033), and in subgroups with reduced LVEF (p=0.019) and single or dual-chamber devices (p=0.048, See Figure). Although there was a trend towards reduced TR in CRT patients, this did not reach significance (p=0.321). Significant improvement in LVEF was noted among those who received HBP with reduced LVEF at baseline (mean increase 5?11%, p=0.020).Conclusion:In contrast to traditional RV pacemakers, patients undergoing HBP demonstrate improved TR in follow-up, particularly those with LVEF <50% at baseline receiving implant for traditional bradycardia indications.