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Approach to permanent His bundle pacing in challenging implants
Right ventricular apical pacing has been the cornerstone of bradycardia pacing for decades. It is well established that right ventricular pacing leads to ventricular dyssynchrony, reduced left ventricular function, and heart failure.1,2 Since the initial description of permanent His bundle pacing (HBP) by Deshmukh et al in 2000,3 several investigators have demonstrated the clinical utility of HBP in patients with atrioventricular (AV) nodal block, infranodal AV block, and bundle branch block.4–7 Increasing interest in HBP has been hampered in part by challenges and limitations associated with a limited implantation tool set.
