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. 2021 Oct;32(10):2692-2703.
doi: 10.1111/jce.15213. Epub 2021 Aug 26.

Safety and feasibility of conduction system pacing in patients with congenital heart disease

Óscar Cano  1   2 , Gopi Dandamudi  3 , Robert D Schaller  4 , Víctor Pérez-Roselló  1 , Hebert D Ayala  1 , Maite Izquierdo  1 , Joaquín Osca  1 , María-José Sancho-Tello  1 , Joaquín Rueda  1 , Eladio Ruiz  1 , Beatriz Insa  1 , Luis Martínez-Dolz  1   2 , Pugazhendhi Vijayaraman  5
Affiliations

Safety and feasibility of conduction system pacing in patients with congenital heart disease

Óscar Cano et al. J Cardiovasc Electrophysiol. 2021 Oct.

Abstract

Introduction: Conduction system pacing (CSP) has emerged as an ideal physiologic pacing strategy for patients with permanent pacing indications. We sought to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with congenital heart disease (CHD).

Methods: Consecutive patients with CHD in which CSP was attempted were included. Safety and feasibility, implant tools and electrical parameters at implant and at follow-up were evaluated.

Results: A total of 20 patients were included (10 with a previous device). A total of 10 patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. CSP was achieved in 75% of cases (10 His bundle pacing, 5 left bundle branch pacing) with left ventricular septal pacing in the remaining 5 patients. Procedure times and fluoroscopy times were prolongued (126 ± 82 min and 27 ± 30 min, respectively). Ventricular lead implant times widely varied ranging from 4 to 115 min, (mean 31 ± 28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 145 ± 36 ms at baseline to 116 ± 18 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.95 ± 0.65 V; R wave amplitude 9.2 ± 8.8 mV and pacing impedance 632 ± 183 Ohms, and remained stable at a median follow-up of 478 days (interquartile range: 225-567). Systemic ventricle systolic function and NYHA class (1.50 ± 0.51 vs. 1.10 ± 0.31; p = .008) significantly improved at follow-up. Lead revision was required in one patient at Day 4.

Conclusions: Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.

Keywords: His bundle pacing; conduction system pacing; congenital heart disease; left bundle branch area pacing.

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References

REFERENCES

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