Ventricular Resynchronization by Implementation of Direct His Bundle Pacing in a Patient with Congenital Complete AV Block and Newly Diagnosed Cardiomyopathy


  • Correction made after online publication December 6, 2010: the author listing has been updated.

  • Dr. Lustgarten is a consultant, advisor, and receives research support from Medtronic. He is a consultant for Biosense-Webster and St. Jude. Dr. VanBuren is an advisor for Medtronic. Other authors: No disclosures.

Daniel L. Lustgarten, M.D., Ph.D., McClure 1 Cardiology, 111 Colchester Avenue, Burlington, VT 05401, USA. Fax 802 847-8818; E-mail:


Direct His Bundle Pacing in Congenital AV Block. Congenital complete atrioventricular block (CCAVB) is usually due to failure of AV nodal conduction with preservation of the His Purkinje system, typically present at birth. While most patients with CCAVB ultimately require pacemaker therapy to restore physiologic heart rates, recent studies have suggested that chronic right ventricular (RV) pacing in patients with CCAVB can have detrimental effects on cardiac structure and function, and may account for a 7–10% incidence of congestive heart failure in these patients. Since the His Purkinje system is preserved in CCAVB, this patient population could be uniquely well served by direct His bundle pacing (DHBP) which would be expected to restore physiologic activation of both ventricles. We present a case of a young woman who presented with RV pacing-induced cardiomyopathy who responded dramatically to DHBP. (J Cardiovasc Electrophysiol, Vol. 22, pp. 818-821, July 2011)