Introduction
His bundle pacing (HBP) recruits the native His Purkinje system by transmitting the electrical pacing impulse directly to the electrical conduction system of the heart. As such, HBP provides physiologic pacing by avoiding ventricular dyssynchrony as is typically seen with right ventricular (RV) pacing.1-3 HBP requires correct placement of the pacing lead onto the His bundle. The anatomy of the His bundle, its course along the ventricular septum and the amount of adjacent myocardium vary among patients4 and may contribute to different electrophysiological pacing responses. Safety issues on HBP mostly considered stability of pacing thresholds and the need for lead revisions.5, 6 However, there are no reports on how HBP may affect the integrity of the ventricular septum.