Safety and feasibility of conduction system pacing in patients with congenital heart disease. (26th August 2021)

• Record Type: Journal Article
• Authors: Cano, Óscar; Dandamudi, Gopi; Schaller, Robert D.; Pérez‐Roselló, Víctor; Ayala, Hebert D.; Izquierdo, Maite; Osca, Joaquín; Sancho‐Tello, María‐José; Rueda, Joaquín; Ruiz, Eladio; Insa, Beatriz; Martínez‐Dolz, Luis; Vijayaraman, Pugazhendhi
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 10(2021)
• Page Start: 2692
• Page End: 2703
• Publication Date: 2021-08-26
• Subjects: conduction system pacing -- congenital heart disease -- His bundle pacing -- left bundle branch area pacing; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15213
• Languages: English
• ISSNs: 1045-3873

Abstract

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.