Direct His bundle pacing using retrograde mapping in complete heart block and L-transposition of the great arteries

Key Teaching Points•Levo-transposition of the great arteries (L-TGA) is associated with variable anatomical location of the coronary sinus, making cardiac resynchronization therapy device implantation a challenge.•Permanent His bundle pacing (HBP) is a feasible option in patients with L-TGA with complete heart block and hostile coronary sinus anatomy.•In complete antegrade atrioventricular block, retrograde His activation may be useful for mapping the His bundle, facilitating successful HBP. •Levo-transposition of the great arteries (L-TGA) is associated with variable anatomical location of the coronary sinus, making cardiac resynchronization therapy device implantation a challenge.•Permanent His bundle pacing (HBP) is a feasible option in patients with L-TGA with complete heart block and hostile coronary sinus anatomy.•In complete antegrade atrioventricular block, retrograde His activation may be useful for mapping the His bundle, facilitating successful HBP.