Feasibility and safety of left bundle branch area pacing in patients with surgical VSD closure

Left bundle branch area pacing (LBBAP) provides more physiological pacing. Conduction continuity can be affected in patients with ventricular septal defect (VSD) closure due to patch material. We aimed to demonstrate the safety and feasibility of LBBAP in patients with surgical VSD closure. This is a multicenter, retrospective observational study including patients with surgical VSD closure who underwent LBBAP. Pre- and post-procedure data were included. Outcomes of the procedure have been demonstrated as well. A total of 23 patients with surgical VSD closure were included. The median age was 17 years (range: 12–31). Baseline left ventricular ejection fraction was preserved in the majority of patients. Baseline QRS duration was 150 ms (122–178), which narrowed to a final paced QRS duration of 117 ms (111–126). LBBAP was successfully achieved in 19 patients (82%). Among successful cases, pacing types included non-selective LBBP in 43%, LVSP in 30%, selective LBBP in 9%. In cases where LBBAP could not be achieved, additional LV lead was implanted via the coronary sinus to improve ventricular synchrony. Procedure-related complications were infrequent and included one lead dislodgement and one late septal perforation. LBBAP can be safely performed in patients with surgical VSD closure with an acceptable success rate. In cases where LBBAP was unsuccessful, LOT-CRT may serve as an effective alternative to maintain ventricular synchrony.