Contemporary review of the management of left ventricular thrombus

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI) and other cardiomyopathies. LVT increases the risk of stroke and systemic embolism, hence treatment with oral anticoagulation is indicated. While the initial treatment options for LVT is clear, the management of patients after the initial duration of anticoagulation is more complex and varied.

Purpose

We aimed to undertake a comprehensive literature review to study the currently available evidence regarding not only the initial type and duration of anticoagulation for LVT, but also potential treatment options after the initial period of anticoagulation in the setting of both LVT persistence and resolution.

Methods

MEDLINE, EMBASE, Scopus, and Google Scholar were searched from inception to August 2022. Data from randomized controlled trials (RCTs), observational studies and case series discussing management of LVT were included in this summarized synthesis.

Results

Of 2050 studies screened, 30 studies (24 observational studies, 3 case series, 2 RCTs, 1 non-randomized, open-label trial) were included. A total of 17 studies compared warfarin with direct oral anticoagulants (DOACs) for the initial anticoagulation strategy, with the vast majority showing similar outcomes (Table 1). Half (n = 9/18) of the studies repeated imaging between 3-6 months. All studies (n=30) used transthoracic echo with or without contrast as the imaging modality of choice, with selected patients undergoing computed tomography (CT) or cardiac magnetic resonance (CMR). If the LVT persisted, most studies recommended continuing anticoagulation (n = 11/16, 69%) or switching to a different class of anticoagulants (n = 6/16, 38%). In the event of LVT non-resolution, high-risk features of embolization (protruding, mobile vs layered clot) may aid in the discussion of risk and benefit of long-term anticoagulation. Even upon resolution of the LVT, some studies (n=5) recommend continuing anticoagulation in the presence of high-risk features of recurrence (eg. persistently depressed left ventricle ejection fraction (LVEF) and/or apical wall dyskinesis). Regardless, medical management should be optimized together with the appropriate revascularization strategy as clinically indicated.

Conclusions

Current evidence on the management of LVT is limited. This updated review summarizes the available evidence for the management for LVT. Evidence-based recommendations on the management of these patients is warranted to appropriately guide clinicians.

Catheter ablation vs medical therapy for treatment of atrial fibrillation patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation (CA) is used as a treatment option in selected patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) as studies have shown that it reduces heart failure (HF) hospitalization, improves survival, and reduces rates of AF recurrence when compared to medical therapy. However, it is not known whether this benefit persists in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose

The aim of this meta-analysis is to compare CA versus medical therapy in patients with AF and HFpEF

Methods

MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from August 2012 to August 2022. All randomized controlled trials (RCTs), propensity score matched (PSM) studies, and observational studies including conference abstracts providing outcomes in patients with HFpEF and AF after CA were included. Outcomes examined include all-cause mortality, HF hospitalizations, and AF recurrence. A random-effects model using R statistical software was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results

Of 3151 studies screened, 8 studies (1 RCT, 4 PSM, 3 observational) were included with a pooled population of 2171 and 24087 patients with AF and HFpEF who underwent CA and medical therapy respectively. There were no significant differences in baseline age (70.6 vs 70.7, p = 0.16), proportion of hypertension (85.0% vs 86.4%, p = 0.58), diabetes (33.8% vs 35.8%, p = 0.39), coronary artery disease (40.2% vs 41.8%, p = 0.06), or men (42.3 vs 36.6%, p = 0.42). After a mean weighted follow-up of 9.45 months, there was no significant difference in all-cause mortality (OR 0.77 [0.47-1.26], p = 0.07), HF hospitalizations (OR 0.44 [0.18-1.08], p = 0.22), but a significantly lower rate of AF recurrence (OR 0.22 [0.09-0.54], p = 0.001) associated with CA.

Conclusion

In patient with HFpEF, CA significantly reduced AF recurrence compared with medical therapy but with no difference in mortality or HF hospitalization. CA continues to have an important role to play in treatment of AF even in HFpEF patients.

Case report: Fully endoscopic microvascular decompression for trigeminal neuralgia

Microvascular decompression is safe, effective, and micro-invasive. Due to these advantages, it has become the mainstream treatment for trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm. Initially, microvascular decompression was performed under a microscope, which limited the light source and visualization capabilities. With the development of endoscopic technology, the endoscope has been used in microvascular decompression, which further improved the visualization range and light source properties. The purpose of the present study was to investigate the efficacy of fully endoscopic microvascular decompression for the treatment of trigeminal neuralgia. In total, three patients with trigeminal neuralgia who underwent fully endoscopic microvascular decompression were evaluated. After surgery, the facial pain of all patients was significantly relieved. In addition, there were no obvious postoperative complications and no recurrence after 6 months of follow-up. These excellent surgical outcomes indicate that fully endoscopic microvascular decompression is an effective and safe method for the treatment of trigeminal neuralgia. Furthermore, it also shows that the endoscope presents advantages for use in microvascular decompression.

Case report: Fully endoscopic microvascular decompression for glossopharyngeal neuralgia

With the advances in endoscopic technology, endoscopy is widely used in many neurosurgical procedures, such as microvascular decompression, which is an effective method to treat glossopharyngeal neuralgia, trigeminal neuralgia, and facial spasm. The purpose of this study was to determine the efficacy of fully endoscopic microvascular decompression in the treatment of glossopharyngeal neuralgia. We managed a patient with glossopharyngeal neuralgia in our department, whose main clinical manifestation was recurrent left ear and facial pain for 3 years. The patient underwent a fully endoscopic microvascular decompression. The pain in the left ear and face was significantly relieved postoperatively, and there was no recurrence at the 6-month follow-up evaluation. We describe a case of glossopharyngeal neuralgia that was successfully treated by fully endoscopic microvascular decompression, which showed that endoscopy has advantages in microvascular decompression, and fully endoscopic microvascular decompression is an effective method for glossopharyngeal neuralgia.

Construction of self-healing polyethersulfone ultrafiltration membrane by cucurbit[8]uril hydrogel via RTIPS method and host-guest chemistry

In this work, the self-healing polyethersulfone ultrafiltration membrane constructed by host-guest chemistry between cucurbit [8]uril (CB [8] is a family of macrocyclic compounds comprising 8 glycoluril units) and two guest molecules based on reverse thermally induced phase separation (RTIPS) method was developed, which had excellent self-healing performance, better mechanical properties, and high permeation flux and BSA rejection rate. The membrane autonomously restored it BSA rejection rate up to about 89% from rejection rate levels as low as 21% after damage. The observed self-healing performance were attributed to the swelling of pore-filled CB [8] hydrogel into the damage position, the molecular interdiffusion of the hydrogel chains, the strong hydrogen bond of the hydrogel chains and the host-guest interaction between CB [8] and two guest molecules (HEC-Np and PVA-MV). SEM morphologies illustrated that the prepared pore-filled membrane via the RTIPS method had homogeneous and porous skin surface and sponge-like cross-section, which imparted the prepared membranes with improved permeability and better mechanical properties. Properties of MR-CB [8] membranes, which varied with increased content of CB [8], were evaluated by permeability, water contact angle, thermogravimetric analysis (TGA), mechanical properties, FRR, scanning electron microscope (SEM) and atomic force microscopy (AFM). The contact angle water showed that CB [8] hydrogel enhanced the surface hydrophilicity of the prepared membrane. TGA illustrated that the thermal stability improved with the increased content of CB [8]. The optimal pore-filled CB [8] hydrogel membrane (MR-CB [8]₂) exhibited that the pure water flux reached 2100.5 L/m² h, while the BSA rejection rate remained at 86.0%. The results of this work suggested pore-filled CB [8] hydrogel membrane was a more promising way to develop polyethersulfone ultrafiltration membranes with self-healing performance.

Electrochemical-enhanced Fe3O4/biochar activates peroxymonosulfate (E/nano-Fe3O4/BC/PMS) for degradation of oxytetracycline

To find cost-effective and environmentally friendly free radical activators to stimulate peroxymonosulfate (PMS) oxidative degradation of organic pollutants, nano-Fe₃O₄/biochar (BC) composites were prepared and characterized in this work to examine their effectiveness in stimulating PMS oxidative degradation of Oxytetracycline (OTC) in water enhanced with electrochemical degradation. When the mass ratio of nano-Fe₃O₄ to BC is 1:1, the catalyst nano-Fe₃O₄/BC exhibits the most obvious degradation effect on OTC. After 4 h of degradation, the OTC concentrations were reduced from 20 to 2.65 mg L^-1, while treated with a single nano-Fe₃O₄ and a single BC are reduced by only 67.7% and 61.8%. Anions HCO₃^- and H₂PO₄^- significantly inhibit OTC degradation, and HCO₃^- has a stronger inhibitory effect than H₂PO₄^-, while Cl^- and NO₃^- can promote OTC degradation. Quenching test and electron spin paramagnetic resonance (EPR) detection showed that singlet oxygen (¹O₂) was the main active species in the degradation process, followed by hydroxyl radical (·OH). When reused for the third time, the removal rate of OTC by nano-Fe₃O₄/BC composites with mass ratios of 1:4, 1:2 and 1:1 was still more than 70%. Therefore, the nano-Fe₃O₄/BC composite is a promising PMS activator, which can realize the rapid oxidative degradation of OTC.

Vapor-Deposited Amino Coupling of Hybrid Perovskite Single Crystals and Silicon Wafers toward Highly Efficient Multiwavelength Photodetection

The complementary integration of perovskite single crystals (PSCs) and silicon-based circuitry provides a feasible way to combine their superiority toward efficient multiwavelength photodetection and imaging readout; however, it suffers from distinct lattice mismatch as well as the ambiguous coupling interface effect. Herein, we develop a vacuum-assisted vapor deposition strategy to realize an ultrauniform aminosiloxane interface-modified silicon wafer, which enables the monolithic epitaxial growth of PSCs with the highest mechanical coupling strength up to 340,000 N m^-2 achieved so far. According to the molecular coupling engineering development with different aminosiloxanes, we achieve a highly efficient multiwavelength-responsive integrated photodetector, possessing specific photodetectivity values of 4.36 × 10¹² jones and 4.55 × 10¹¹ jones within the visible and NIR regions, respectively, as well as the lowest X-ray detection limit of 42.6 nGy_air s^-1. Moreover, a particularly wide -3dB cut-off frequency of 6350 Hz as well as a 120 dB linear dynamic range (LDR) also endows the integrated device with excellent dynamic photodetection capability. This work provides an efficacious approach in the integration technology for PSC-based optoelectronic applications.

Laminate Design of Carbon-Fiber-Reinforced Resin Matrix Composites for Optimized Mechanical Properties and Electrical Conductivity

Carbon fiber composites as pantograph slide materials are in the development stage, in which copper is the conductive phase, and the addition form and size need to be designed. Herein, the effects of the copper morphology, the size of the copper mesh on the performance, and the influence of the contact mode between the sliding plate and bracket on the temperature rise were compared and analyzed. The resistivity is 11.2 μΩ·m with the addition of 20 wt% copper mesh, a relative reduction of 91.77%. Importantly, the impact strength is increased by 14.19%, and the wear is reduced by 13.21%; hence, the copper mesh laid in layers is the ideal structure. Further study of the distribution and quality of the copper mesh shows that the resistivity is related only to the quality of the copper mesh; in addition, the number of layers of the copper mesh cannot exceed 16, and it is determined that the best type of copper mesh is 5#. Notably, the performance can be improved by appropriately reducing the thickness of the copper mesh and increasing the aperture while the sliding plate and the bracket are connected by copper mesh with conductive adhesive, which has the slowest heating rate of 2.27 °C/min and the smallest resistance. Therefore, the influence of copper content and distribution on the electrical conductivity are systematically investigated, and the mechanical properties and electrical conductivity are optimized through the design of the laminate structure of the compound material.

Electrochemical-enhanced MoS2/Fe3O4 peroxymonosulfate (E/ MoS2/Fe3O4/PMS) for degradation of sulfamerazine

Seeking effective methods to degrade organic pollutants has always been a hot research field. In this work, MoS₂/Fe₃O₄ catalyst was synthesized by hydrothermal method with MoS₂ as carrier to construct an advanced oxidation system of electrochemical enhanced MoS₂/Fe₃O₄-activated peroxymonosulfate (E/MoS₂/Fe₃O₄/PMS). The materials were characterized by X-ray diffraction, transmission electron microscopy and X-ray photoelectron spectroscopy. The degradation efficiency of sulfamerazine (SM1) by E/MoS₂/Fe₃O₄/PMS system was investigated and reaction mechanism was explored. The results showed that the removal rates of SM1 within 30 min were 31%, 20% and 89% with Fe₃O₄, MoS₂ and MoS₂/Fe₃O₄ as catalysts, respectively. The characterization results revealed that Fe(III) on the surface of Fe₃O₄ was reduced to Fe(II) and Mo(IV) was oxidized to Mo(VI) in the presence of MoS₂. The synergistic effect between Fe₃O₄ and MoS₂ enhanced the PMS decomposition and improved the SM1 removal efficiency. Free radical quenching experiments showed that SO₄^-⋅, ·OH, O₂· and ¹O₂ were all involved in the degradation of SM1, and the effect of ¹O₂ was more significant than other active substances. Low concentrations of Cl^- and humic acid (HA) had no significant inhibitory effect on the degradation of SM1, while HCO₃^- had a significant inhibitory effect on the E/MoS₂/Fe₃O₄/PMS system. In addition, catalyst cycling experiments showed that MoS₂/Fe₃O₄ maintained good stability before and after the catalytic reaction process.

Hysteresis analysis reveals dissolved carbon concentration - discharge relationships during and between storm events

The dissolved carbon concentration, which is responsible for aquatic ecosystem productivity and water quality, is tightly coupled with hydrological processes. Excess dissolved carbon may exacerbate eutrophication and hypoxia in aquatic ecosystems and lead to deterioration of water quality. Storm events dominate the dynamics of dissolved carbon concentrations, and this nonlinear behavior exhibits significant time scale dependence. Here, we identified inter- and intra-event variability in the dissolved carbon concentration-discharge (C-Q) relationship in an agriculture-intensive catchment. The driving factors of C-Q hysteresis patterns for dissolved inorganic carbon (DIC) and organic carbon (DOC) were quantified by redundancy analysis combined with hierarchical partitioning. At the inter-event scale, DIC exhibited mainly clockwise hysteresis, indicating an exhaustible, proximal source (e.g., groundwater). However, DOC hysteresis was generally counter-clockwise, indicating distal and plentiful sources (e.g., soil water) in the agricultural catchment. Hierarchical partitioning showed that total rainfall, peak discharge and flood intensity explained 28.38% of the total variation in C-Q hysteresis for DIC and 39.87% for DOC at the inter-event scale. At the intra-event scale, time series analysis of dissolved carbon concentration and discharge indicated the interconversion of supply limitation to transport limitation, which depends on the activation of the specific DIC or DOC source zones. These findings provide significant insights into understanding the dynamics of dissolved carbon during storm periods and are important for targeted watershed management practices aimed at reducing carbon loading to surface waters.

Integrated System for On-Site Rapid and Safe Screening of COVID-19

Since the outbreak of coronavirus disease 2019 (COVID-19), the epidemic has been spreading around the world for more than 2 years. Rapid, safe, and on-site detection methods of COVID-19 are in urgent demand for the control of the epidemic. Here, we established an integrated system, which incorporates a machine-learning-based Fourier transform infrared spectroscopy technique for rapid COVID-19 screening and air-plasma-based disinfection modules to prevent potential secondary infections. A partial least-squares discrimination analysis and a convolutional neural network model were built using the collected infrared spectral dataset containing 857 training serum samples. Furthermore, the sensitivity, specificity, and prediction accuracy could all reach over 94% from the results of the field test regarding 968 blind testing samples. Additionally, the disinfection modules achieved an inactivation efficiency of 99.9% for surface and airborne tested bacteria. The proposed system is conducive and promising for point-of-care and on-site COVID-19 screening in the mass population.

[Analysis of HIV transmission hotspots and characteristics of cross-regional transmission in Guangxi Zhuang Autonomous Region based on molecular network]

Objective: To analyze HIV transmission hotspots and characteristics of cross-regional transmission in Guangxi Zhuang autonomous region (Guangxi) based on the molecular network analysis, and provide evidence for optimization of precise AIDS prevention and control strategies. Methods: A total of 5 996 HIV pol sequences sampled from Guangxi between 1997 and 2020 were analyzed together with 165 534 published HIV pol sequences sampled from other regions. HIV-TRACE was used to construct molecular network in a pairwise genetic distance threshold of 0.5%. Results: The proportion of HIV sequences entering the molecular network of HIV transmission hotspots in Guangxi was 31.5% (1 886/5 996). In the molecular network of HIV cross-regional transmission, the links within Guangxi accounted for 51.6% (2 613/5 062), the links between Guangxi and other provinces in China accounted for 48.0% (2 430/5 062), and the links between Guangxi and other countries accounted for 0.4% (19/5 062). The main regions which had cross-regional linked with Guangxi were Guangdong (49.5%, 1 212/2 449), Beijing (17.5%, 430/2 449), Shanghai (6.9%, 168/2 449), Sichuan (5.7%, 140/2 449), Yunnan (4.2%, 102/2 449), Shaanxi (3.8%, 93/2 449), Zhejiang (2.8%, 69/2 449), Hainan (2.0%, 49/2 449), Anhui (1.5%, 37/2 449), Jiangsu (1.3%, 33/2 449), and other regions (each one <1.0%), respectively. The risk factors of entering the molecular network of HIV transmission hotspots in Guangxi included being aged ≥50 years (compared with being aged 25-49 years, aOR=1.68,95%CI:1.46-1.95), males (compared with females, aOR=1.21,95%CI:1.05-1.40), being single (compared with being married, aOR=1.18,95%CI:1.00-1.39), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.21,95%CI:1.04-1.42), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=1.77, 95%CI:1.48-2.12). The risk factors of cross-regional transmission included males (compared with females, aOR=1.74,95%CI:1.13-2.75), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.96,95%CI:1.43-2.69), being freelancer/unemployed/retired (compared with being farmers, aOR=1.50,95%CI:1.07-2.11), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=3.28,95%CI:2.30-4.72). Conclusion: There are HIV transmission hotspots in Guangxi. Guangxi and other provinces in China form a complex cross-regional transmission network. Future studies should carry out social network surveys in high-risk populations inferred from the molecular network analysis for the timely identification of hidden transmission chains and reduction of the second-generation transmission of HIV.

Hybrid Graph Transformer for Tissue Microstructure Estimation with Undersampled Diffusion MRI Data

Advanced contemporary diffusion models for tissue microstructure often require diffusion MRI (DMRI) data with sufficiently dense sampling in the diffusion wavevector space for reliable model fitting, which might not always be feasible in practice. A potential remedy to this problem is by using deep learning techniques to predict high-quality diffusion microstructural indices from sparsely sampled data. However, existing methods are either agnostic to the data geometry in the diffusion wavevector space ( q -space) or limited to leveraging information from only local neighborhoods in the physical coordinate space ( x -space). Here, we propose a hybrid graph transformer (HGT) to explicitly consider the q -space geometric structure with a graph neural network (GNN) and make full use of spatial information with a novel residual dense transformer (RDT). The RDT consists of multiple densely connected transformer layers and a residual connection to facilitate model training. Extensive experiments on the data from the Human Connectome Project (HCP) demonstrate that our method significantly improves the quality of microstructural estimations over existing state-of-the-art methods.

Genomic testing for copy number and single nucleotide variants in spermatogenic failure

PURPOSE

To identify clinically significant genomic copy number (CNV) and single nucleotide variants (SNV) in males with unexplained spermatogenic failure (SPGF).

MATERIALS AND METHODS

Peripheral blood DNA from 97/102 study participants diagnosed with oligozoospermia, severe oligozoospermia, or non-obstructive azoospermia (NOA) was analyzed for CNVs via array comparative genomic hybridization (aCGH) and SNVs using whole-exome sequencing (WES).

RESULTS

Of the 2544 CNVs identified in individuals with SPGF, > 90% were small, ranging from 0.6 to 75 kb. Thirty, clinically relevant genomic aberrations, were detected in 28 patients (~ 29%). These included likely diagnostic CNVs in 3/41 NOA patients (~ 7%): 1 hemizygous, intragenic TEX11 deletion, 1 hemizygous DDX53 full gene deletion, and 1 homozygous, intragenic STK11 deletion. High-level mosaicism for X chromosome disomy (~ 10% 46,XY and ~ 90% 47,XXY) was also identified in 3 of 41 NOA patients who previously tested normal with conventional karyotyping. The remaining 24 CNVs detected were heterozygous, autosomal recessive carrier variants. Follow-up WES analysis confirmed 8 of 27 (30%) CNVs (X chromosome disomy excluded). WES analysis additionally identified 13 significant SNVs and/or indels in 9 patients (~ 9%) including X-linked AR, KAL1, and NR0B1 variants.

CONCLUSION

Using a combined genome-wide aCGH/WES approach, we identified pathogenic and likely pathogenic SNVs and CNVs in 15 patients (15%) with unexplained SPGF. This value equals the detection rate of conventional testing for aneuploidies and is considerably higher than the prevalence of Y chromosome microdeletions. Our results underscore the importance of comprehensive genomic analysis in emerging diagnostic testing of complex conditions like male infertility.

[Variables associated with hematological remission and survival in patients with acute myeloid leukemia after induction failure and relapse]

Objective: This study aimed to explore variables associated with remission rate and survival in patients with acute myeloid leukemia (AML) after induction failure and relapse. Methods: Data of 373 consecutive patients with AML were analyzed after induction failure and relapse. Binary logistics and the Cox model regression were used to identify variables associated with remission rate and outcomes. Results: In patients with AML after induction failure and relapse, the total CR+CRi rates were 50.6% and 40.3%, respectively; among those who achieved CR/CRi, the 3-year RFS rates were 34.4% and 30.4%, respectively, and the 3-year overall survival rates were 40.1% and 31.6%, respectively. In the multivariate analyses, using CLAG or FLAG regimen as a re-induction chemotherapy regimen, age <39 years and SWOG low-risk were significantly associated with higher remission rates in patients with induction failure. Male, secondary AML, SWOG high-risk, the interval from the first remission to relapse within 12 months, and bone marrow blasts ≥20% at the time of relapse were significantly associated with lower remission rates in relapsed patients. Transplantation was significantly associated with prolonged relapse-free survival and overall survival in patients achieving hematologic remission; the SWOG low-risk group was significantly associated with longer overall survival in those with induction failure; and achieving CR (not CRi) or having female gender was associated with longer RFS or overall survival in relapsed patients. Conclusion: Reinduction chemotherapy regimen, age, gender, SWOG risk, secondary AML, the interval from the first remission to relapse, and bone marrow blast percentage at the time of relapse were significantly associated with remission rates in the patients with AML after induction failure and relapse. Transplantation, SWOG low-risk, achieving CR, or female gender were associated with longer survivals in those achieving remission.

[Effectiveness investigation on left bundle branch area pacing in 10 infants and toddlers]

Objective: To explore the feasibility, safety and effectiveness of left bundle branch area pacing (LBBAP) in children aged ≤3 years. Methods: A total of 10 children aged ≤3 years who were diagnosed with brady arrhythmia in the First Hospital of Tsinghua University from September 2020 to September 2021 were retrospectively analyzed. All the children met the indication of permanent pacemaker implantation and underwent LBBAP successfully. The intraoperative data (pacing parameters, electrocardiogram and radiographic imaging), cardiac ultrasound data and clinical data during regular postoperative follow-up were recorded. The preoperative and postoperative data were compared using matched samples t test. Results: Ten children (aged (1.6±0.7) years with weight of (10.3±2.5) kg) underwent LBBAP successfully. The QRS wave duration on the postoperative electrocardiogram was (100±9) ms, and the percentage of ventricular pacing was (97±7)%. The postoperative follow-up period was 6 (6, 12) months. At 1 week after operation, the left ventricular end-diastolic diameter Z scores in these children reduced significantly compared with those before operation (1.3±0.6 vs. 3.6±1.1, t=9.37, P<0.001). During the follow-up period, cardiac function was normal and the last left ventricular ejection fraction was (66±4)% in all children. At the last follow-up, the pacing threshold of the 10 children was smaller than 1.0 V and was acceptable. Compared with the intraoperative baseline values, the pacing threshold was slightly higher ((0.8±0.1) vs. (0.5±0.1) V, t=-5.27, P=0.001). However, no significant difference was found regarding sensing threshold ((16±5) vs. (14±4) mV, t=-0.83, P=0.426) and impedance ((584±88) vs. (652±86) Ω, t=2.26, P=0.050). During follow-up, no electrode related complications were recorded. Conclusions: LBBAP is safe and effective for infants and toddlers. Narrow QRS pacing with stable pacing parameters and normal cardiac function could be achieved postoperatively.