Key result
Leadless and conduction system pacing offer promising safety in complex congenital heart disease, contrasting high epicardial failure.
Why the study?
As more patients with complex congenital heart disease survive to adulthood, the need for pacemaker procedures is increasing, yet evidence in the most complex groups is often limited to expert centre opinion, small numbers, and mixed paediatric/adult data.
This narrative minireview highlights that while evidence is limited to small studies and expert centers, novel percutaneous technologies such as leadless pacemakers and conduction system pacing offer promising alternatives to traditional epicardial or transvenous pacing in adults with complex congenital heart disease.
Answers are grounded in this paper and cite their sources.
Should not yet change epicardial pacing practice in complex CHD; leaves open prospective trials of leadless and conduction system approaches.
Congenital heart disease (CHD) is a growing health care problem, as more pediatric patients survive to adulthood every year as the number of patients with complex conditions also increases.As more patients survive, there has been an increase in the need for pacemaker procedures.Historically, there has been a focus on epicardial pacing in the most complex groups.In this review, we examine the background epidemiology, existing evidence for pacing, extraction data in three of the most complex CHD groups-transposition of the great arteries with an atrial switch procedure, patients palliated with a Fontan procedure and univentricular hearts.In this expert narrative review, we have used a broad search strategy of PubMed supplemented with evidence where available from non-congenital cohorts.The evidence in these most complex cohorts can be limited to expert centre opinion, small numbers and mixed paediatric/adult data.We discuss below the available data, the limitations and the novel approaches available in centres to deal with the most complex conditions such as conduction system pacing and leadless pacing with promising results albeit in expert centres only.Whilst current applicability to a wider range of institutions is not yet suggested by the paper, this review hopefully illustrates potential options for consideration and research in the future.
No takes yet. Share an insight, caveat, or question.
Papaioannou et al. (2026) conducted a review in Complex congenital heart disease (transposition of the great arteries with an atrial switch procedure, Fontan palliation, and univentricular hearts). Percutaneous pacing strategies (leadless pacemakers and conduction system pacing) vs. Traditional epicardial or standard transvenous pacing was evaluated. Leadless and conduction system pacing show promising safety in complex congenital heart disease (0.5% LPM complication rate), compared to 10-year epicardial lead failure rates of 28%-40%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: