Introduction
In recent years, His bundle pacing has emerged as a more physiologic
alternative to right ventricular (RV) pacing1.
However, despite a reasonable success rate2, this
procedure has yet to gain universal acceptance. Direct left bundle
branch or intra-septal pacing has been recently proposed as a valid,
technically feasible alternative3 that may result in
comparable benefits. Initial reports with this method have been
encouraging, although long-term data remain scarce. We present a case of
an adverse outcome possibly caused by direct left bundle branch pacing
and reversed by an upgrade to a biventricular system.