{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:23:29Z","timestamp":1787203409526,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Left bundle branch area pacing (LBBAP) has emerged as a promising alternative to right ventricular apical pacing in patients with congenital heart disease (CHD), yet its application in this population remains underexplored despite unique anatomical and physiological challenges. This review synthesizes current evidence on LBBAP in CHD, including anatomical considerations of the conduction system, lead selection between lumenless and stylet\u2010driven leads, technical modifications for different substrates, and clinical outcomes. In congenitally corrected transposition of the great arteries (CCTGA), the paradoxically anterior conduction system creates favorable anatomy for LBBAP, with reported success rates of 86%\u2013100% in small observational series. CHD\u2010specific data from Moore et\u00a0al. demonstrated superior QRS narrowing with conduction system pacing (CSP) compared to conventional CRT (35 vs. 14\u00a0ms;\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.04). One randomized trial and multiple meta\u2010analyses comparing lumenless and stylet\u2010driven leads demonstrate comparable success rates but distinct safety profiles, with implications for lead choice in CHD patients requiring lifelong pacing. The 2023 HRS\/APHRS\/LAHRS and 2025 ACC\/AHA guidelines now recognize CSP as a therapeutic option in selected patients, though these endorsements are not specific to LBBAP in CHD. CHD\u2010specific evidence remains limited to case series and small observational studies. This review provides a practical framework for patient selection, lead choice, and procedural planning while identifying key research priorities for this growing patient population.\n                  <\/jats:p>","DOI":"10.1111\/pace.70402","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:25:27Z","timestamp":1787199927000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Bundle Branch Area Pacing in Congenital Heart Disease: Current Evidence, Challenges, and Future Directions"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8790-9169","authenticated-orcid":false,"given":"Reisuke","family":"Yoshizawa","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1161\/01.CIR.52.3.435","article-title":"Electrophysiological Delineation of the Specialized A\u2010V Conduction System in Patients With Corrected Transposition of the Great Vessels and Ventricular Septal Defect","volume":"52","author":"Waldo A. L.","year":"1975","journal-title":"Circulation"},{"key":"e_1_2_18_3_1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ijcard.2013.11.128","article-title":"Adverse Impact of Chronic Subpulmonary Left Ventricular Pacing on Systemic Right Ventricular Function in Patients With Congenitally Corrected Transposition of the Great Arteries","volume":"171","author":"Yeo W. T.","year":"2014","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_18_4_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2023.131230","article-title":"Safety and Efficacy of Left Bundle Branch Area Pacing Compared With Right Ventricular Pacing in Patients With Bradyarrhythmia and Conduction System Disorders: Systematic Review and Meta\u2010Analysis","volume":"390","author":"Leventopoulos G.","year":"2023","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_18_5_1","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.hrthm.2023.03.1538","article-title":"2023 HRS\/APHRS\/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failure","volume":"20","author":"Chung M. K.","year":"2023","journal-title":"Heart Rhythm"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.09.006"},{"key":"e_1_2_18_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.cjca.2017.09.013","article-title":"A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block","volume":"33","author":"Huang W.","year":"2017","journal-title":"Canadian Journal of Cardiology"},{"key":"e_1_2_18_8_1","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1016\/j.hrthm.2019.05.011","article-title":"Prospective Evaluation of Feasibility and Electrophysiologic and Echocardiographic Characteristics of Left Bundle Branch Area Pacing","volume":"16","author":"Vijayaraman P.","year":"2019","journal-title":"Heart Rhythm"},{"key":"e_1_2_18_9_1","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1161\/01.CIR.67.6.1374","article-title":"Complete Atrioventricular Block in Patients With Atrioventricular Discordance","volume":"67","author":"Huhta J. C.","year":"1983","journal-title":"Circulation"},{"key":"e_1_2_18_10_1","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.hrcr.2021.12.001","article-title":"Left Bundle Pacing in Transposition of the Great Arteries With Previous Atrial Redirection Operation","volume":"8","author":"O'Connor M.","year":"2022","journal-title":"HeartRhythm Case Reports"},{"key":"e_1_2_18_11_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jacep.2022.10.012","article-title":"Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease","volume":"9","author":"Moore J. P.","year":"2023","journal-title":"JACC Clinical Electrophysiology"},{"key":"e_1_2_18_12_1","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.amjcard.2004.02.056","article-title":"Relation of Right Ventricular Pacing in Tetralogy of Fallot to Electrical Resynchronization","volume":"93","author":"Stephenson E. A.","year":"2004","journal-title":"American Journal of Cardiology"},{"key":"e_1_2_18_13_1","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.jacc.2022.05.053","article-title":"Impact and Modifiers of Ventricular Pacing in Patients With Single Ventricle Circulation","volume":"80","author":"Chubb H.","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_18_14_1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.cjcpc.2022.01.004","article-title":"Cardiac Resynchronization Therapy Using Single Site Left Ventricular Pacing in a Tricuspid Atresia Patient With Left Bundle Branch Block","volume":"1","author":"Ono S.","year":"2022","journal-title":"CJC Pediatric and Congenital Heart Diseases"},{"key":"e_1_2_18_15_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.hrthm.2020.01.033","article-title":"Permanent Conduction System Pacing for Congenitally Corrected Transposition of the Great Arteries","volume":"17","author":"Moore J. P.","year":"2020","journal-title":"Heart Rhythm"},{"key":"e_1_2_18_16_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/europace\/euac175","article-title":"Left Bundle Branch Area Pacing in Congenital Heart Disease","volume":"25","author":"O'Connor M.","year":"2023","journal-title":"Europace"},{"key":"e_1_2_18_17_1","doi-asserted-by":"crossref","first-page":"2692","DOI":"10.1111\/jce.15213","article-title":"Safety and Feasibility of Conduction System Pacing in Patients With Congenital Heart Disease","volume":"32","author":"Cano O.","year":"2021","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_18_18_1","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.hrcr.2025.06.027","article-title":"Rescue Left Bundle Branch Area Pacing for a Patient With Malfunctioning Epicardial Biventricular Pacing in Congenitally Corrected Transposition of the Great Arteries: A Case Report","volume":"11","author":"Yoshizawa R.","year":"2025","journal-title":"HeartRhythm Case Reports"},{"key":"e_1_2_18_19_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s00246-022-02942-9","article-title":"Conduction System Pacing in Pediatrics and Congenital Heart Disease, a Single Center Series of 24 Patients","volume":"45","author":"Gordon A.","year":"2024","journal-title":"Pediatric Cardiology"},{"key":"e_1_2_18_20_1","article-title":"Left Bundle Branch Area Pacing in Children: Case Series","volume":"9","author":"J\u0119drzejczyk\u2010Patej E.","year":"2025","journal-title":"European Heart Journal: Case Reports"},{"key":"e_1_2_18_21_1","doi-asserted-by":"crossref","DOI":"10.15420\/aer.2024.09","article-title":"Conduction System Pacing in Children and Congenital Heart Disease","volume":"13","author":"Cano O.","year":"2024","journal-title":"Arrhythmia & Electrophysiology Review"},{"key":"e_1_2_18_22_1","article-title":"Comparison of Procedural Outcomes of Lumenless Fixed\u2010Helix Versus Stylet\u2010Driven Extendable\u2010Helix Lead Systems in Left Bundle Branch Pacing: COMPARE LBBP","volume":"17","author":"Shroff J. P.","year":"2024","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_18_23_1","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1186\/s12872-024-04273-4","article-title":"Stylet\u2010Driven Leads Compared With Lumenless Leads for Left Bundle Branch Area Pacing: A Systematic Review and Meta\u2010Analysis","volume":"24","author":"Chen X.","year":"2024","journal-title":"BMC Cardiovascular Disorders"},{"key":"e_1_2_18_24_1","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/pace.15217","article-title":"Comparing Efficacy and Complications Between Stylet\u2010Driven Leads and Lumenless Leads in Left Bundle Branch Area Pacing","volume":"48","author":"Sripusanapan A.","year":"2025","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_18_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-025-02673-w"},{"key":"e_1_2_18_26_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jacep.2024.09.020","article-title":"Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing: the LIFE\u2010LBBAP Study","volume":"11","author":"De Pooter J.","year":"2025","journal-title":"JACC Clinical Electrophysiology"},{"key":"e_1_2_18_27_1","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.hroo.2023.11.014","article-title":"Acute Performance of Stylet Driven Leads for Left Bundle Branch Area Pacing: A Comparison With Lumenless Leads","volume":"4","author":"Cano \u00d3.","year":"2023","journal-title":"Heart Rhythm O2"},{"key":"e_1_2_18_28_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2024.132879","article-title":"Real\u2010World Adoption of Left Bundle Branch Area Pacing: Insights From the Conduction\u2010System Pacing Italian Network Group (C\u2010SING)","volume":"421","author":"Dell'Era G.","year":"2025","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_18_29_1","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1093\/eurheartj\/ehac445","article-title":"Left Bundle Branch Area Pacing Outcomes: The Multicentre European MELOS Study","volume":"43","author":"Jastrz\u0119bski M.","year":"2022","journal-title":"European Heart Journal"},{"key":"e_1_2_18_30_1","doi-asserted-by":"crossref","first-page":"e624","DOI":"10.1016\/j.hrthm.2026.01.004","article-title":"Effectiveness of Cardiac Resynchronization Therapy in Adult Congenital Heart Disease: A Meta\u2010Analysis of Biventricular and Conduction System Pacing Outcomes","volume":"23","author":"Zwaenepoel B. A. C.","year":"2026","journal-title":"Heart Rhythm"},{"key":"e_1_2_18_31_1","article-title":"Long\u2010Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single\u2010Center Study","volume":"14","author":"Su L.","year":"2021","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_18_32_1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s10840-023-01626-5","article-title":"Success and Complication Rates of Conduction System Pacing: A Meta\u2010Analytical Observational Comparison of Left Bundle Branch Area Pacing and His Bundle Pacing","volume":"67","author":"Parlavecchio A.","year":"2024","journal-title":"Journal of Interventional Cardiac Electrophysiology"},{"key":"e_1_2_18_33_1","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy","volume":"42","author":"Glikson M.","year":"2021","journal-title":"European Heart Journal"},{"key":"e_1_2_18_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.10.028"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70402","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70402","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:25:32Z","timestamp":1787199932000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":33,"alternative-id":["10.1111\/pace.70402"],"URL":"https:\/\/doi.org\/10.1111\/pace.70402","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"assertion":[{"value":"2026-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70402"}}