• Catalin Pestrea, Alexandra Gherghina, Florin Ortan, Gabriel Cismaru, and Rosu Radu.
• Department of Interventional Cardiology, Brasov County Emergency Clinical Hospital.
• Medicine (Baltimore). 2020 Aug 7; 99 (32): e21633.

IntroductionPacing of the His bundle and conduction system seems an attractive site for pacing. Lead placement in His-pacing might be technically challenging due to surrounding structures and particular anatomic location.Patient ConcernsA 62-years old male patient was admitted for recurrent syncope. Electrocardiographic monitoring revealed periods of complete atrioventricular block with left branch block morphology and a QRS duration of 160 ms.DiagnosisA diagnosis of intermittent complete atrioventricular block was made with a Class I indication of permanent dual-chamber cardiac pacing.InterventionsA lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead was placed at the septal area of the atrioventricular junction with good pacing and sensing thresholds. An important narowing of the QRS was observed.OutcomesAfter the procedure, good pacing and sensing parameters were observed.Echocardiography revealed disappearance of the previously recorded ventricular dyssynchronism.Device follow-up at 1 month and 3 months showed stable pacing and sensing parameters.ConclusionPacing the distal His bundle normalized the QRS complex, therefore "curing" both the atrioventricular and the left bundle branch conduction abnormalities. As such, the technique can be used as an alternative to cardiac electrical resynchronization therapy with acceptable pacing and detection thresholds and better ventricular activation pattern.

14 keywords...

hide…