Para-Hisian Pacing for a Pediatric Patient with a Congenitally Corrected Transposition of the Great Arteries (SLL)

Conduction System Pacing in Pediatrics and Congenital Heart Disease: A Case Report and Literature Review

Conduction system pacing involving either His bundle pacing (HBP) or left bundle branch pacing (LBBP) is a modality that has been introduced as a safe and effective alternative to right ventricular (RV) pacing to help prevent pacemaker-associated cardiomyopathy. While HBP has been employed in the pediatric and congenital populations, several small studies have shown LBBP to be safe and effective in the pediatric population. We present a patient with congenital atrioventricular block and postoperative ventricular septal defect repair cardiomyopathy with subsequent left ventricular function improvement following a transition from an RV epicardial pacemaker system to an LBBP system. This case report serves as a foundation for a review of the current state of LBBP in pediatrics and congenital heart disease.

Three-dimensional mapping for His-bundle pacing in pediatric patients, a case series

INTRODUCTION

Pediatric patients who receive pacemakers may have a lifetime of repeat exposure to fluoroscopy. His bundle pacing may provide better long-term pacing for these patients. To minimize fluoroscopy and for improved localization of the His bundle, we utilized three-dimensional mapping to guide His bundle pacing and we follow-up short-term results.

METHODS

An Octapolar Livewire catheter (Abbott, Minneapolis, USA) was used for mapping and location of the His bundle while 3-dimensional mapping via the EnSite Precision system (Abbott Medical, Abbott Park, IL) was utilized to create a 3-dimensional geometry. The EnSite Precision system also mapped and recorded His bundle signal strengths and earliest ventricular activation or retrograde His bundle activation.

RESULTS

Three patients are presented and followed for 4-5 months. The ages ranged from 10 to 15 years with 1 male patient. Diagnoses including progressive atrioventricular block, alternating bundle branch block and atrioventricular canal defect with complete heart block. All patients received selective His-bundle pacing systems. The range in fluoroscopy time was 6.4 to 9.9 min with 5.64 mGy to 10.18 mGy. Stable lead thresholds, impedances and sensing were present at last follow-up.

CONCLUSIONS

His bundle pacing in our 3 pediatric patients including one with altered His-bundle physiology (case 3 with atrioventricular canal defect) was successful with good short-term follow-up results.

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

Long-term right ventricular pacing is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatric patients and those with congenital heart disease (CHD). Research has shown that pacing-induced cardiomyopathy can be reversed with nonselective or selective His bundle pacing in adults, however, the information available about the use of this type of therapy in pediatrics and CHD is scarce. We performed a retrospective chart review of all the cases of His or left bundle pacing at the University of Minnesota, division of Pediatric Cardiology from January of 2019 to April of 2020. Parametric data are presented as mean ± standard deviation. Non-parametric data are presented as median value with interquartile ranges. Eight patients, ages 8 to 18 years (median of 11.5) and weight from 21.5 to 81.6 kg (median of 40 kg) underwent this procedure successfully. The most common structural heart disease was a repaired peri-membranous ventricular septal defect. Three patients (37.5%) had selective and three (37.5%) had nonselective His bundle pacing, and two patients (25%) had left bundle pacing. There were two cases of pacing-induced cardiomyopathy and each had a 14% and 16% improvement of the ejection fraction after nonselective His bundle pacing. There were no procedural complications. Selective and nonselective His bundle, as well as left bundle pacing may be a feasible procedure in pediatric patients with and without CHD. This procedure may improve pacing-induced cardiomyopathy in this population.