Long-Term Performance of Conduction System Pacing in Patients With Congenital Heart Disease.

Abstract

BACKGROUND: Conduction system pacing (CSP) is safe and feasible in congenital heart disease (CHD), but long-term follow-up data remain scarce. OBJECTIVE(S): To evaluate the long-term performance of CSP in patients with CHD. METHOD(S): This retrospective, multicenter, international study included CHD patients undergoing CSP-His bundle pacing (HBP) or left bundle branch area pacing (LBBAP)-with >=12 months follow-up. The primary endpoint was survival free from CSP lead-related complications (loss of conduction system capture, significant threshold rise >=2.5 V or >=2.0 V increase, or lead reintervention). Secondary endpoints included implant success, electrical and echocardiographic outcomes, and clinical status. RESULT(S): 144 patients were included (88% moderate/complex CHD; 26% systemic right ventricle [SRV]; 24% with CRT indication); 29 HBP, 115 LBBAP. Acute implant success was 95.1%. Over a median follow-up of 32.2 months (interquartile range [IQR]: 18.2-47.1), survival free from CSP lead-related complications was 0.89, with 88% of CSP lead-related events occurring beyond 12 months of follow-up. Device-related complications occurred in 11.8%, and reinterventions in 5.1%. Microdislodgment (14.6%), threshold increase (6.9%), and loss of conduction system capture (5.6%) were less frequent with LBBAP. LVEF improved in systemic left ventricle patients while SRV patients preserved fractional area change. Among patients with CRT indications, systemic ventricular function improved from 34 +/- 10% to 41 +/- 13% (p<0.001). CONCLUSION(S): CSP is feasible across a broad spectrum of CHD and is associated with preservation or improvement of systemic ventricular function. Late lead-related complications are not negligible, underscoring the need for long-term follow-up. Copyright © 2026. Published by Elsevier Inc.