Feasibility and safety of left bundle branch area pacing in patients with VSD closure: case series

Conduction system runs posteroinferior to the associated VSD, which after surgical repair, can be damaged. In the past, traditional transvenous or epicardial pacemakers have been implanted. Recently, left bundle branch area pacing provides more physiological pacing and has been shown to be effective and safe. Penetration of the lead inside the septum along with capturing the conduction system is crucial. However, in patients with ventricular septal closure with patch material continuity of conduction can be affected. Therefore, we aimed demonstrate safety and feasibility of LBBAP in patients with VSD closure.

This is a multicenter, retrospective observational data including patients with surgical VSD closure and complete heart block. All patients underwent LBBAP. Pre- and post-procedure data were included. Outcomes of the procedure have been demonstrated as well.

Overall, seven patients with VSD closure have been included from 4 centers. Clinical characteristics of the cases are depicted in Table 1. Mean age was 22.5 (min: 12 and max 42) years. Average EF was 43 (min: 27 and max: 60) %. Baseline and paced QRS durations were as follows: 178 (min 130 and max 232) ms and 130 (min 102 and max 170) ms, respectively. Procedure data is shown in Table 2. LBBAP was successfully performed in 3 patients (43 % success). Of successful 3 LBBAP cases, ns-LBBAP achieved in 2 cases and one case was determined as LVSP. However, two of four failed patients underwent left bundle branch optimized CRT (LOT CRT) and rest 2 patients had deep septal pacing (DSP). No acute complication has been reported.

Although LBBAP can be achieved in more than 80 % of cases in patients with VSD patch success rate is significantly lower. This can be explained with damaged conduction system by VSD patch. Nonetheless, first time we showed that in cases where LBBAP was not successful LOT CRT can be offered with better QRS narrowing compared to LBBAP alone (Figure).

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