When implanting a permanent His bundle pacemaker with an RV lead, improper setting of the post-atrial pacing ventricular blanking period in MVP mode can cause inappropriate pacing due to intermittent His bundle capture.
May prompt closer follow-up in His bundle pacing; leaves open optimal management of incomplete capture.
Key Teaching Points•Even if high output cannot capture the His bundle, there is a possibility that a patient’s posture, heartbeat, or respiration can affect pacing.•Intermittent His bundle capture can cause inappropriate pacing. If intermittent His bundle capture is seen, the mode and post–atrial pacing ventricular blanking period of the pacemaker should be checked.•Incomplete His bundle capture might not be able to preserve left ventricular function; therefore, regular follow-up is needed, and upgrading the pacemaker to cardiac resynchronization therapy should be considered proactively. •Even if high output cannot capture the His bundle, there is a possibility that a patient’s posture, heartbeat, or respiration can affect pacing.•Intermittent His bundle capture can cause inappropriate pacing. If intermittent His bundle capture is seen, the mode and post–atrial pacing ventricular blanking period of the pacemaker should be checked.•Incomplete His bundle capture might not be able to preserve left ventricular function; therefore, regular follow-up is needed, and upgrading the pacemaker to cardiac resynchronization therapy should be considered proactively.
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Tateishi et al. (2022) studied this question.
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