His Bundle and Left Bundle Pacing in Pediatrics and Congenital Heart Disease: A Single Center Experience

Guo

Cardiovasc electrophysiol

et al. 2022

Introduction: Left bundle branch area pacing (LBBAP) maintains electrical and mechanical synchronization of the ventricles. It is a relatively physiological pacing mode, with low and stable pacing threshold and wider indications. LBBAP in children has been rarely reported. Methods: This study observed 12 children attempted LBBAP from January 2019 to January 2021 in the department of pediatric cardiology of Anzhen Hospital prospectively. Clinical data, pacing parameters, electrocardiograms, intracardiac electrograms, echocardiographic measurements and complications were recorded at implant and during follow-up. Results: The 12 patients aged between 3 and 14 years old and weighted from 13 to 48 kg. Eleven patients were diagnosed with third-degree atrioventricular block and 1 patient (case 4) suffered from cardiac dysfunction due to right ventricular apical pacing (RVAP). Left bundle branch area pacing was successfully achieved in all patients with narrow QRS complexes and V1 lead showed changes like right bundle branch block in the pacing electrocardiogram. Left ventricular ejection fraction in case 4 recovered on the 3rd day after LBBAP. The median of left ventricular end diastolic diameter Z score of the 12 patients decreased from 1.75 to 1.05 3 months after implantation (p < 0.05). The median of paced QRS duration was 103 ms. The median of pacing threshold, R-wave amplitude and impedance were 0.85 V, 15 mV and 717 Ω respectively and remained stable during follow-up. No complications such as loss of capture, lead dislodgement or septal perforation occurred. Conclusions: Left bundle branch area pacing can be performed safely in children with narrow QRS duration and stable pacing parameters. Cardiac dysfunction caused by long-term RVAP can be corrected by LBBAP quickly.

Section: Discussionmentioning

confidence: 99%

“…The pacing mode should be converted to physiological pacing or CRT. Single‐site pacing is the major practical advantage of LBBAP compared with biventricular pacing, and it can prolong the battery longevity and reduce the potential vascular problems and lead‐associated complications 35 . Therefore, LBBP was first tried in this study.…”

Section: Discussionmentioning

confidence: 99%

Preliminary study on left bundle branch area pacing in children: Clinical observation of 12 cases

Guo

Cardiovasc electrophysiol

et al. 2022

Current Opinion in Pediatrics

“…However, the positions of the AV node and His bundle in certain congenital heart lesions are displaced from the structurally normal heart due to alterations in the embryologic migration of the four specialized myocardial rings that form the progenitor cardiac conduction system. Case reports have shown 14–16% improvements in LV ejection fraction with selective and nonselective HBP [23 ▪▪ ]. There are inherent challenges in optimal lead placement as an example, the membranous septum is thin and multiple attempts to screw in a lead can potentially result in perforation.…”

Section: Physiologic Site-specific Pacingmentioning

confidence: 99%

The history of cardiac pacing in the young and a look to the future

Cohen

Thurber

2022

Purpose of reviewThe purpose of this review is to explore the historical and serendipitous events that led to the creation of modern-day pacemakers. In addition, this review will explore how contemporary conduction site-specific pacing has overcome some of the deleterious effects from historical chronic right ventricular apical pacing.Recent findingsRecently, there have been tremendous advances in not just the lead design but the tools required to promote more physiologic pacing. Although cardiac resynchronization pacing has been around for nearly 2 decades, this review also introduces and discusses the early results of His-bundle pacing and left bundle branch pacing and some of the potential applicability of this technology for our children.SummaryPacemakers have evolved significantly in the last 30 years through collaborative partnerships between physicians and engineers. The future of cardiac pacing is bright compared to the field of electrotherapy 50 years ago. Future iterations of pacemakers must consider unusual anatomy and growing children. Pediatric patients contribute to a small percentage of the overall device volume, but the majority of these patients will have a pacemaker for life. We need to be proactive and consider what are the best short and long-term solutions for this cohort.

Cardiovasc electrophysiol

“…On the other hand, CHD patients may derive the most benefit with physiological pacing considering young age at the time of implant as well as presence of structural heart disease, which have been associated with the developement of pacemaker induced cardiomyopathy. However, data on safety and feasibility of CSP in CHD is scarce and currently limited to case reports and small series 12–14 …”

Section: Introductionmentioning

confidence: 99%

“…However, data on safety and feasibility of CSP in CHD is scarce and currently limited to case reports and small series. [12][13][14] The aim of this study was to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with a wide range of CHD subtypes, including complex anatomies and postsurgical correction status.…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of conduction system pacing in patients with congenital heart disease

Cano

Dandamudi

Schaller

et al. 2021

Introduction Conduction system pacing (CSP) has emerged as an ideal physiologic pacing strategy for patients with permanent pacing indications. We sought to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with congenital heart disease (CHD). Methods Consecutive patients with CHD in which CSP was attempted were included. Safety and feasibility, implant tools and electrical parameters at implant and at follow‐up were evaluated. Results A total of 20 patients were included (10 with a previous device). A total of 10 patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. CSP was achieved in 75% of cases (10 His bundle pacing, 5 left bundle branch pacing) with left ventricular septal pacing in the remaining 5 patients. Procedure times and fluoroscopy times were prolongued (126 ± 82 min and 27 ± 30 min, respectively). Ventricular lead implant times widely varied ranging from 4 to 115 min, (mean 31 ± 28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 145 ± 36 ms at baseline to 116 ± 18 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.95 ± 0.65 V; R wave amplitude 9.2 ± 8.8 mV and pacing impedance 632 ± 183 Ohms, and remained stable at a median follow‐up of 478 days (interquartile range: 225–567). Systemic ventricle systolic function and NYHA class (1.50 ± 0.51 vs. 1.10 ± 0.31; p = .008) significantly improved at follow‐up. Lead revision was required in one patient at Day 4. Conclusions Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.