OPTImizing Lead Placement in Patients Requiring Pacemaker After Cardiac Surgery

Conventional right ventricular pacing has been associated with ventricular dyssynchrony and an increased risk of pacing-induced cardiomyopathy, which may lead to worse clinical outcomes. To lessen the burden of pacing-induced cardiomyopathy, the adoption of conduction system pacing has increased in recent years. In patients with normal cardiac function, measured as left ventricular ejection fraction, the superiority of conduction system pacing is less clear. As a result, both pacing strategies remain in widespread clinical use. Patients undergoing cardiac surgery represent a vulnerable cohort for pacing-induced cardiomyopathy, given their established structural heart disease, and postoperative atrioventricular block remains a common occurrence in these patients. This multicenter randomized trial aims to evaluate the use of conduction system pacing, in the form of left bundle branch area pacing, versus conventional pacing in patients with normal left ventricular ejection fraction after cardiac surgery.