Subvalvular His bundle pacing can restore atrioventricular synchrony in pseudo-pacemaker syndrome when supravalvular capture thresholds are high.
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May offer pacing alternative in refractory pseudo-pacemaker syndrome; hypothesis-generating and requires prospective validation.
Key Teaching Points•Atrioventricular dyssynchrony as an etiology of decreased exercise tolerance should be considered in patients with a prolonged PR interval.•His bundle pacing should be considered in patients with pseudo-pacemaker syndrome, as it restores atrioventricular synchrony while maintaining interventricular synchrony.•If supravalvular His bundle pacing capture thresholds are high, then one should consider placing the His lead subvalvularly. •Atrioventricular dyssynchrony as an etiology of decreased exercise tolerance should be considered in patients with a prolonged PR interval.•His bundle pacing should be considered in patients with pseudo-pacemaker syndrome, as it restores atrioventricular synchrony while maintaining interventricular synchrony.•If supravalvular His bundle pacing capture thresholds are high, then one should consider placing the His lead subvalvularly.
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Shah et al. (2018) studied this question.
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