Left bundle branch area pacing in complex congenital heart disease: Overcoming access limitations in patients with unconventional central venous anatomy

Left bundle branch area (LBBA) pacing is the preferred modality for conduction system pacing (CSP) given its ability to restore physiological heart activation combined with consistency of successful lead implantation and performance (1). This approach to pacing reduces the risk of pacing-induced cardiomyopathy seen with conventional single-site ventricular pacing and is a form of cardiac resynchronization therapy in patients with atrioventricular or intraventricular conduction disease and systolic heart failure.