Fig. 2

A. Angiography shows the tip of the sheath did not reach to the septum. Left anterior oblique 45 fluoroscopic view. B. Electrode-incorporated steerable catheter (Abbott Agilis HisPro™). Reshaping the catheter proximal (primary curve) allowed for an extended reach so that the pacing lead could be positioned inferior to the previously attempted site toward the apex. The further addition of a septal curve would allow us to maintain a catheter orientation perpendicular to the septum. C. Fluoroscopic image of the tricuspid annulus and actual placement of the ventricular lead to capture the left fascicular bundle. First, proximal left bundle branch capture was attempted at the initial site. Then, the left septal fascicle was captured at the final site. Right anterior oblique 30 fluoroscopic view