Introduction
Conduction system pacing (CSP) including His bundle pacing (HBP) and
left bundle branch area pacing (LBBAP) has been demonstrated to be safe
and feasible in a wide range of patients with bradycardia pacing
indications such as AV nodal or infrahisian AV
block1-2. Recently, CSP has also been shown to be
effective in other more challenging scenarios including pacemaker
induced cardiomyopathy and patients with indications for cardiac
resynchronization therapy3-5. Patients with congenital
heart disease (CHD) are known to be at higher risk of developing
conduction disturbances, especially in some specific anatomic
variants6. Anatomic challenges are common,
particularly if the patient has undergone surgical correction/palliation
of the primary defect or if prosthetic valves, surgical patches or
conduits are present7-11. On the other hand, CHD
patients may derive the most benefit with physiological pacing
considering young age at the time of implant as well as presence of
structural heart disease, which have been associated with the
developement of pacemaker induced cardiomyopathy. However, data on
safety and feasibility of CSP in CHD is scarce and currently limited to
case reports and small series of adult patients with congenitally
corrected transposition of the great arteries (cc-TGA) and congenital
complete heart block12-13.
The aim of this study was to evaluate the safety and feasibility of CSP
in a consecutive series of unselected patients with a wide range of CHD
subtypes, including complex anatomies and post-surgical correction
status.