Abstract
BACKGROUND: Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS. METHODS: This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation. RESULTS: One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group (p = 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, p = 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, p = 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, p = 0.002), but parameters remained stable at 1 year. CONCLUSIONS: LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.