His-Optimized Cardiac Resynchronization Therapy (HOT-CRT) in a subcutaneous ICD patient: first-in-human case report

Recent developments in arrhythmology have enabled the use of new devices, such as subcutaneous implantable cardioverter-defibrillators (s-ICD), and the comeback of older strategies, such as His-Bundle pacing (HBP) in clinical practice, alongside the use of thoroughly proven therapies such as cardiac resynchronization therapy (CRT), e.g. with His-Optimized CRT (HOT-CRT). However, interplay between these new and older techniques is not always clear. We report the first-in-human case of biventricular pacemaker (CRT-P) implantation with HOT-CRT in an s-ICD patient. Paced QRS morphology was similar to the spontaneous morphology, albeit shorter. Correct QRS identification by the s-ICD was confirmed both intra-procedurally and post-procedurally.