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580 (Figure 1). During pacemaker implantation, despite obtaining a nonselective His bundle capture (QRS, 128 ms), attempts to stabilize the pacing lead at the His bundle region were unsuccessful. Therefore, the lead was positioned in the mid­ ­septal region (approximately 2 cm apically from the His bundle region) and deployed deep with­ in the interventricular septum with 10 lead ro­ tations. During progressively deeper lead de­ ployment, typical paced QRS morphology tran­ sition (Figure 1A) and discrete LBB potential were observed (Figure 1D), suggesting the achievement of LBB capture. At mid ­term follow ­up (5 months), the patient is symptom free, and both LBB pac­ ing threshold (0.75 V @0.5 ms) and ventricular sensing (>15 mV) remain excellent.

First Polish experience with permanent direct pacing of the left bundle branch