Utilization of Permanent His-Bundle Pacing for Management of Proarrhythmia Related to Biventricular Pacing

Biventricular pacing has occasionally been associated with ventricular proarrhythmia, which at times can be refractory to conventional antiarrhythmic drug therapy and ablative intervention. Recently, permanent His-bundle pacing has emerged as a reasonable alternative to right ventricular and biventricular pacing. In addition, by maintaining the physiologic pattern of ventricular electrical activation, it is less likely to be arrhythmogenic. We report the use of permanent His-bundle pacing to manage ventricular proarrhythmia that developed after initiation of biventricular pacing and was unresponsive to antiarrhythmic and ablative therapy.