Ruchit Shah, MD, Vineet Kumar, MD, FHRS HeartRhythm Case Reports

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Subvalvular His bundle pacing for pseudo-pacemaker syndrome and mitral regurgitation Ruchit Shah, MD, Vineet Kumar, MD, FHRS HeartRhythm Case Reports Volume 4, Issue 9, Pages 425-428 (September 2018) DOI: 10.1016/j.hrcr.2018.06.008 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Pre-HBP implant echocardiogram showing a markedly prolonged PR interval (arrows showing P waves). B: Post-HBP implant echocardiogram showing normalization of the PR interval with a close-up lead V1 showing a stimulus to QRS of ∼45 ms (red arrow showing an interval), which is similar to the HV interval of 52 ms seen during the electrophysiology study. HBP = His bundle pacing. HeartRhythm Case Reports 2018 4, 425-428DOI: (10.1016/j.hrcr.2018.06.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Pre-HBP implant transthoracic echocardiogram showing diastolic mitral regurgitation with (A) color Doppler and (B) continuous wave Doppler. Post-HBP implant transthoracic echocardiogram showing resolution of diastolic mitral regurgitation with (C) color Doppler and (D) continuous wave Doppler. HBP = His bundle pacing. HeartRhythm Case Reports 2018 4, 425-428DOI: (10.1016/j.hrcr.2018.06.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A: Post-HBP implant chest radiograph showing RA lead, His bundle lead, and RV lead. B: Post-HBP implant transthoracic echocardiogram showing a His bundle lead in the subvalvular position. C, D: Post-HPB implant computed tomography scans showing a His bundle lead in the subvalvular position. AV = atrioventricular; HBP = His bundle pacing; RA = right atrial; RCA = right coronary artery; RV = right ventricular. HeartRhythm Case Reports 2018 4, 425-428DOI: (10.1016/j.hrcr.2018.06.008) Copyright © 2018 Heart Rhythm Society Terms and Conditions