Abstract
Right ventricular pacing has been reported to result in ventricular dyssynchrony, heart failure, and increased mortality. Direct His Bundle pacing (DHBP) is a more physiological alternative.1 There has been disagreement regarding the location of the DHBP lead with respect to the plane of the tricuspid valve (TV).2 We present a patient with DHBP and imaging visualization of the location of the pacing lead. A 42-year-old man with persistent atrial fibrillation, mildly reduced left ventricular function, and sinus and atrioventricular nodal dysfunction underwent a dual chamber pacemaker implantation using the Select Secure Medtronic 3830 ventricular lead with a Medtronic Select Site deflectable catheter (C304) by mapping the HB with unipolar recordings from the lead tip.
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