Anatomical approach to permanent His bundle pacing: Optimizing His bundle capture ★

• Permanent His bundle pacing is a physiologic alternative to right ventricular pacing.
• Capture and conduction through His bundle occurs in both Selective and Nonselective His bundle pacing.
• Understanding the anatomy and course of the His bundle is essential for successful His bundle pacing.
• His bundle pacing can be successfully achieved in majority of patients with nodal and infra-nodal AV block.

Permanent His bundle pacing is a physiological alternative to right ventricular pacing. In this article we describe our approach to His bundle pacing in patients with AV nodal and intra-Hisian conduction disease. It is essential for the implanters to understand the anatomic variations of the His bundle course and its effect on the type of His bundle pacing achieved. We describe several case examples to illustrate our anatomical approach to permanent His bundle pacing in this article.

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