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.