Michael R. Kaufmann , MD , 1 , Matthew S. McKillop , MD, FHRS 1 , Thomas A. Burkart , MD, FACC, FHRS 1 , Mark Panna , MD, FACC, FHRS 1 , William M. Miles , MD, FACC, FHRS 1 , C. Richard Conti , MD, MACC 1
Permanent pacemaker implant is a commonly performed cardiac procedure for treatment of bradycardia or conduction system abnormality. With conventional right ventricular (RV) pacing a lead is implanted at the RV apex or on the RV septum. However, RV apical or RV septal pacing causes iatrogenic left bundle-branch block and ventricular dyssynchrony and can lead to adverse cardiac remodeling, a pacing-mediated cardiomyopathy, and congestive heart failure. Alternatively, permanent His-bundle pacing uses the intrinsic rapidly-conducting His-Purkinje system to activate the ventricle, thereby maintaining (or sometimes even restoring) ventricular synchrony. Many patients may derive benefit from permanent His-bundle pacing.