Abstract
An 81-year-old man with second-degree atrioventricular block was admitted to our centre for pacemaker implantation. Electroanatomic mapping and intracardiac echocardiography-guided left-bundle branch area pacing was performed, entirely without fluoroscopy. It is the first report to describe intracardiac echocardiography for guiding sheath movements into the heart. In conclusion, the combined use of intracardiac echocardiography and intracardiac navigation system allows us to perform left-bundle branch pacing without fluoroscopy.