Use of adjunctive 3-dimensional echocardiogram for His bundle pacing in pediatric patients

The right ventricle has been the traditional site of transvenous pacing, but targeting the His bundle has emerged as potentially more physiologic, with reductions in pacemaker-mediated cardiomyopathy being suggested. Although the use of His bundle pacing (HBP) has increased dramatically since it was first clinically introduced in 2000,1 reports in pediatric patients and those with congenital heart disease are limited.2,3 Improvements in procedural success and reductions in fluoroscopy times have been sought with the addition of 3-dimensional (3-D) electroanatomic mapping4,5 to mark the His bundle.