Abstract
His bundle pacing (HBP) offers physiologic pacing by placing the pacing
lead directly to the His bundle. We present a case in which a HBP lead,
implanted at the fragile membranous septum, resulted in a persistent
restrictive peri-membranous ventricular septal defect (VSD). This
complication of HBP has not been reported before but brings new insights
in the discussion regarding the optimal position of a pacing lead in the
ventricular septum. The fragility of the membranous septum and low rate
of spontaneous closure of membranous VSD, might favor lead placement in
the muscular septum when aiming for physiologic pacing.