BACKGROUND: Ebstein's anomaly is a rare congenital heart disease characterized by apical displacement of the tricuspid valve and a small functional right ventricle. Surgical repair, particularly cone reconstruction, may be complicated by atrioventricular conduction disturbances requiring permanent pacing. CASE SUMMARY: A 47-year-old woman with Ebstein's anomaly underwent cone repair and developed complete heart block postoperatively. Because of her distorted right-sided anatomy and concerns regarding long-term dys-synchrony with right ventricular endocardial pacing, left bundle branch area pacing was performed. Despite technical challenges, successful lead implantation was achieved, resulting in narrow QRS complexes and stable pacing parameters with preserved tricuspid valve function at follow-up. DISCUSSION: Conduction system pacing provides a physiological alternative to conventional right ventricular pacing in patients with complex congenital heart disease. TAKE-HOME MESSAGE: Left bundle branch area pacing is feasible after cone repair and may be considered in selected patients with Ebstein's anomaly.
Yadav et al. (2026) studied this question.