Direct His-Bundle Pacing Improved Left Ventricular Function and Remodelling in a Biventricular Pacing Nonresponder

The optimal pacing modality after atrioventricular junction (AVJ) ablation remains unclear. Herein, we describe the case of a heart failure patient who had AVJ ablation for chronic atrial fibrillation and received a cardiac resynchronization therapy defibrillator device. Because of the lack of clinical response to biventricular pacing, the device was revised with the addition of direct His bundle pacing, which resulted in significant improvement in functional status and left ventricular indices. This case illustrated direct His bundle pacing as an alternative for conventional biventricular pacing in some cardiac resynchronization therapy nonresponders who undergo AVJ ablation for atrial fibrillation and have an intact distal conduction system.