Direct His-bundle Pacing in a Patient with a Persistent Left Superior Vena Cava.

We report a case of direct His-bundle lead placement at the time of implantable cardioverter-defibrillator insertion and atrioventricular node ablation. The patient was found to have an isolated persistent left superior vena cava, and selective His-bundle pacing was successfully achieved through the use of a steerable sheath and dedicated mapping catheter.