Conclusion
This case report describes the occurrence of an iatrogenic peri-membranous VSD as an unexpected complication of HBP. Routine echocardiographic screening of the ventricular septum following pacing lead implantation in the septum is recommended. Insights into the incidence of VSD associated with novel pacing strategies can contribute to the ongoing discussion which pacing site at the septum is best suited for achieving safe and effective physiological pacing.