Guiding Pacemaker Implantation With Multimodality Imaging in an Adult With Ventricular Septal Defect.

CASE SUMMARY: A 57-year-old man with a history of congenital ventricular septal defect and bicuspid aortic valve with surgical repair of aortic coarctation presented with dyspnea and found to be in complete heart block with junctional escape rhythm necessitating pacemaker implantation. DISCUSSION: Pacemaker implantation in adult congenital heart disease and atrioventricular block requires preprocedural planning. Multimodality imaging is important in patients with complex septal anatomy, as it can reduce procedural difficulty and improve procedural safety by identifying optimal lead positioning strategies. TAKE-HOME MESSAGE: Multimodality imaging can facilitate safer and more precise pacemaker implantation in adult patients with congenital heart disease with abnormal septal anatomy.