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). Ten patients had complex forms of CHD, 9 moderate
defects and 1 a simple defect. His bundle pacing (HBP) or left bundle
branch area pacing (LBBAP) were achieved in all patients (10 HBP, 5 LBBP
and 5 left ventricular septal pacing). Procedure times and fluoroscopy
times were prolongued (126±82 min and 27±30 min, respectively). CSP lead
implant times widely varied ranging from 4 to 115 minutes, (mean 31±28
min) and the use of multiple delivery sheaths was frequent (50%). The
QRS width was reduced from 144±32 ms at baseline to 116±16 ms with CSP.
Implant electrical parameters included: CSP pacing threshold 0.85±0.61V;
R wave amplitude 9.8±9.2mV and pacing impedance 735±253 Ohms, and
remained stable at a median follow-up of 478 days (IQR 225-567).
Systemic ventricle systolic function and NYHA class (1.50±0.51 vs
1.10±0.31; p=0.008) 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 : conduction system pacing; His bundle pacing; Left
bundle branch area pacing; congenital heart disease.