A study of fifty patients by Y. Hu et al (1) indicates that it does matter. Two problems with His pacing are higher capture threshold voltage are needed and lower R waves . Hu's data indicate that in the 25 patients who were implanted below the TV there were lower ventricular capture thresholds and higher R waves.Echo studies showed no tricuspid regurgitation.
Somewhat different results were reported by Tang et al (2) in that they found capture voltage to be no different in the atrial leads compared to the ventricular lead placement in a study of 13 atrial placed His leads and 16 ventricular placed leads. However, they also found that the R wave sensing values were higher in the ventricular lead group with values at implant being 1.87 V for the atrial lead and 4.53 V for the ventricular group.
Also it is generally thought in cases of AV block that a sub valvular implantation may be preferred and that non-selective His pacing may to preferable to selective because it can be its own back up.
1)Hu,Y Electrical characteristics of pacing different portion of the His bundle in bradycardia patients
Europace,2020 December 26, supplement ii 27
2)Tang, C Effect of implantation site of the His bundle pacing leads on pacing parameters a single center experience BMC Cardiovascular disorders. 2021 Feb 24 2021 (1) 112,
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