Abstract
Permanent His-bundle pacing has been gaining popularity in the adult population requiring cardiac resynchronization therapy. Initial procedural challenges are being overcome, and this method of pacing has been shown to improve left ventricular function and heart failure symptoms secondary to ventricular dyssynchrony. Though the etiologies of ventricular dyssynchrony may differ in children and those with congenital heart disease than in adults with structurally normal hearts, His-bundle pacing may also be a preferred option in these groups to restore more physiologic electric conduction and improve ventricular function. We present a review of the current literature and suggested directions involving deploying permanent His-bundle pacing in the pediatric and congenital heart disease population.
Highlights
The typical electrical activation of the heart propagates as an electrical impulse that travels from the sinus node to the atrioventricular (AV) node, through the His– Purkinje system, and to the ventricular myocardium
Conduction through the His–Purkinje system leads to a narrow QRS complex on the 12-lead electrocardiogram (ECG), representing synchronous left ventricular (LV) and right ventricular (RV) activation
Chronic RV apical pacing leads to altered cardiac activation and mechanics with inherent left bundle branch (LBB) and ventricular dyssynchrony, resulting in reduced systolic function over time due to myocellular remodeling.[1,2,3,4,5]
Summary
The typical electrical activation of the heart propagates as an electrical impulse that travels from the sinus node to the atrioventricular (AV) node, through the His– Purkinje system, and to the ventricular myocardium. This approach would require systemic anticoagulation.[17] Small children with ventricular dyssynchrony are not able to accommodate a pacemaker lead in the coronary sinus or descending coronary veins and so commonly receive epicardial leads if biventricular pacing is desired. The goal of His-bundle pacing is to achieve physiologic ventricular activation where it otherwise cannot exist This can be in cases of Figure 1: A: Anteroposterior chest radiograph showing lead placement in a dual-chamber transvenous pacing system in a structurally normal heart. Both methods of Hisbundle pacing should result in a narrower QRS complex as compared with isolated ventricular myocardial pacing (Figures 3A–3C)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Journal of Innovations in Cardiac Rhythm Management
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
