Safety and feasibility of left bundle branch pacing for pediatric and congenital heart disease patients

Abstract

Abstract Background Conduction system pacing (CSP) has evolved and validated in adults. Due to technical challenges, pediatric and congenital heart disease (CHD) patients were excluded from original trials in this field. We report the safety and feasibility results of our initial experience with pediatric and CHD patients undergoing LBBAP (Left bundle branch area pacing). Purpose To analyze the indications, intraoperative outcomes, electrocardiographic and clinical data from the initial follow-up of pediatric and CHD patients who underwent LBBAP. Methods Indications, intraoperative technical issues, electronic parameters of the implant and early complications of consecutive pediatric and CAD patients submitted to stimulation of the conduction system were evaluated. Results This study was performed between February 2022 and November 2023 and recruited 11 consecutive patients with complete AV block (age: 15-43 years; 7 women) who underwent LBBAP. Four patients had congenital heart disease repaired surgically and two patients with congenitally corrected transposition of the great arteries. Upgrading from VVIR to LBBAP underwent in four patients. Right ventricle (RV) leads were extracted in three patients before CSP. DDD pacemakers with Lumneless 3830 pacing leads were implanted in all patients. The pre-implant QRS duration was 146 (104- 200) ms and 120 (110-130) ms after the procedure. The mean left ventricle activation time was 72 (50-90) ms. The R-wave amplitude was 10.00 (6-29) mV, with a stimulation threshold of 0.8 (0.4-1) V x 0.4 ms and impedance of 676 (534-780) ohms. Transition from non-selective to either myocardial or selective capture and fixation beats were respectively demonstrated in five and three patients. The procedure duration was 125 (70-130) min, and the fluoroscopy time was 15.2 (4-23.6) min. LBBAP substantially shortened the QRS duration and improved LV dyssynchrony echocardiographic parameters in four patients with prior epicardial or endocardial pacing. The LBBAP was successful in all patients with no early complications occured. At mean three months follow-up, QRS duration showed no significant changes compared with baseline. Conclusion Our initial experience on cardiac stimulation of the His-Purkinje conduction system through the stimulation of the left bundle branch is a safe and feasible technique in pediatric and CHD patients. The widespread use of this pacing technique is very useful and cost-effective to prevent heart failure in this vulnerable population.