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Updated: Oct 6, 2025

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Conduction system pacing following septal myectomy: Insights into site of conduction block

Rujie Zheng1,2, Yingxue Dong3, Shengjie Wu1,2

  • 1Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Journal of Cardiovascular Electrophysiology
|January 14, 2022
PubMed

Insights

Left bundle branch area pacing (LBBAP) is a feasible strategy for patients with hypertrophic cardiomyopathy (HCM) and conduction block after septal myectomy. His bundle pacing (HBP) was less successful in these patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Surgery

Background:

  • Septal myectomy for obstructive hypertrophic cardiomyopathy (HCM) can lead to conduction block.
  • The electrophysiological characteristics of this conduction block are not well understood.

Purpose of the Study:

  • To assess the feasibility and safety of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP).
  • To evaluate these pacing strategies in patients with septal myectomy-associated conduction block.

Main Methods:

  • Included patients with HCM and pacing indications post-myectomy.
  • Performed electrophysiological mapping to identify the site of block.
  • Recorded success rates and pacing characteristics of HBP and LBBAP, along with echocardiographic data and complications.

Main Results:

  • Ten patients with atrioventricular block or left bundle branch block post-myectomy were studied.
  • The block was infra-Hisian in nine patients with atrioventricular block.
  • HBP failed in most cases, while LBBAP was successful in nine out of ten patients, significantly narrowing QRS duration.

Conclusions:

  • The conduction block post-myectomy is often infra-Hisian and not amenable to HBP.
  • LBBAP presents a more feasible and physiological pacing strategy for these specific patients.
Abstract

Keywords:
His bundle pacing (HBP)atrioventricular block (AVB)hypertrophic cardiomyopathy (HCM)left bundle branch area pacing (LBBAP)left bundle branch block (LBBB)

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