Background: We present a case series and short review of electroanatomical mapping (EAM)-guided pacing lead implantation. The cases illustrate different aspects of EAM use in special circumstances and summarizes our experience with EAM-guided His lead implantation in 32 consecutive patients. Advantages and caveats encountered when using EAM in device procedures are discussed.

Objective: To illustrate usefulness of EAM-guided lead implantation and computed tomography (CT) image integration in a case series.

Methods: Lead implantation was performed targeting different anatomically defined regions using EAM for mapping and lead navigation, as well as using the system for image integration for 2 cardiac resynchronization therapy implantations.

Results: For His bundle pacing lead implantation, a steep learning curve for successful His bundle lead placement seems obtainable (91%) for new implanters using EAM-guided implantation. Successful lead placements in other locations guided by anatomical or physiologically defined positions are demonstrated in individual cases. However, map shifts are frequently encountered and should be recognized and corrected.

Conclusion: EAM-guided His bundle lead implantation seems to be a useful tool for arriving at high success rates for new His lead implanters with a steep learning curve, if appropriate precautions are undertaken. In selected cases EAM and CT scan image integration can be of benefit in lead implantation in other locations. Knowledge of specific problems in using EAM for device procedures should be recognized.