Pacemaker implants have always posed a continuing challenge to cardiac nurses in learning and handling new equipment and electronic devices. Working with temporary pacemakers, permanent single-chamber, through two-chamber then to multi-chamber devices and implantable cardioverter-defibrillators does not allow us to relax, but dedicated work and progress from all of us. His stimulation as a somewhat newer method of electrostimulation treatment, in addition to all the current technical aspects of the usual implantation of pacemakers, also provides us with some new, specific challenges. (1)

As this is an electrode implantation in a very narrow region of interest, knowledge of the anatomy and physiology of the conduction system of the heart is at most importance. Knowledge of the signal of His potential is also extremely important. And in order to successfully implant such a system, we also need specific materials for the delivery of an adequate (special) electrode to the His region. Due to the location of the His and its participation in the electrical impulse conduction system, it is necessary to be extremely accurate in order to prevent the development of the Exit block, either due to electrode dislocation or insufficient output current. In order to carry out a successful procedure with the operator, the whole team must adequately prepare the room, patient, devices (programmer, ECG, electrophysiology station, materials).

Necessary materials in these procedures are adequate His electrodes without lumens, preformed His introducer for easier placement of the electrode in the region of interest, modification of the electrophysiology system for simultaneous recording of unipolar, bipolar His signals and measurement of stimulation parameters.

Our goal is to show the challenges in the implantation of the His cardiac pacing system, and how we have developed procedure for the implantation of that specific system.