B-PO01-031 CONDUCTION SYSTEM PACING GUIDED BY ELECTROANATOMICAL MAPPING IN PEDIATRICS AND CONGENITAL HEART DISEASE

Abstract

Physiological alternative pacing reduces the risk of heart failure when compared to standard RV pacing. Conduction system pacing is associated with higher fluoroscopy exposure. Cumulative radiation is a growing concern in pediatric patients and those with congenital heart disease. To compare the outcomes of conduction system pacing by electromagnetic guidance versus traditional technique. This is a single center review of all pediatric and congenital heart disease conduction system pacing cases. Electromagnetic mapping was used to locate the lead to minimize fluoroscopy. Anatomy of the RA and the RV were created with activation, voltage and pace mapping. His-bundle region was marked on the 3-dimensional map. The His-bundle sheath was inserted and positioned over an octapolar catheter. Pacing lead was implanted where a His signal was found. Statistical analysis included fluoroscopy time, dose area product (DAP), procedure duration and pacing parameters. This study reviewed a total of 20 cases with a mean age of 14 years (8 to 39 years) and a median follow up of 308 days (14 to 444 days). 10 patients underwent minimal fluoroscopy technique (group A) and 10 patients the standard technique (group B). The mean procedural time was 306.5 ± 69.2 min (group A) and 299.8 ± 72.3 min (group B). Pacing parameters at implantation for groups A and B included stimulation thresholds of 0.73 ± 0.21 V and 0.54 ± 0.04 V (p 0.06), R wave amplitudes of 9.62 ± 4.94 mV and 9.74 ± 6.9 mV (p 0.95), and impedance of 632.7 ± 204.9 and 705.1 ± 164.04 (p 0.39), respectively. In terms of radiation exposure, fluoroscopy time for groups A and B were 13.3 ± 10.7 min and 41.8 ± 15.1 min (p 0.0002), respectively; fluoroscopy doses for groups A and B were 13.2 (3.8 to 125.4) mGy and 54.4 (19.9 to 192.6) mGy (p 0.026), respectively; DAP for groups A and B were 231.7 (16.6 to 2074) cGycm2 and 950.73 (269.4 to 4508.8) cGycm2 (p 0.017), respectively. No complications were seen in this cohort. Electroanatomical mapping for conduction system pacemaker implantation reduces radiation exposure in pediatric and congenital heart disease, without increasing the procedural time or affecting pacing parameters.