Figure 1:
Panel A: First His bundle pacing lead (HBP) implant resulting in selective His bundle pacing (S-HBP, bipolar pacing configuration).
Panel B: Lead revision with implantation of a second HBP lead implant using the dual lead technique. The second HBP lead resulted in non-selective HBP (NS-HBP, unipolar configuration), indicating a more distal lead screw in towards the muscular septum.
Panel S: Transthoracic echocardiography showing the peri-membranous ventricular septum defect (yellow asterisk) proximal in the septum and the more distal implanted second HBP lead (yellow arrow). PLAX: parasternal long axis view, PSAX: Parasternal short axis view.