Feasibility and short-term outcomes of left bundle pacing in paediatric patients: a case series

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Other. Main funding source(s): Government BACKGROUND: Chronic RV apical pacing in pediatric patients can lead to LV dysfunction. Left bundle pacing has been shown to preserve LV function in adults. The feasibility and outcomes of left bundle pacing in pediatric patients are unknown. OBJECTIVES: To study the feasibility, safety, and short-term outcomes of pediatric left bundle branch pacing (LBBp). METHODS: Patients < 18 years with class I or II indication for pacing were the study subjects. All patients had dual-chamber pacemaker implantation from the right or left side. We did the device implantation either under conscious sedation, or general anesthesia, after 6 hours of fasting and intravenous hydration with normal saline at 1 ml/kg/min. A venogram was performed on the ipsilateral to the implantation site from the cubital venous access with 5-10 ml of non-ionic contrast side to delineate the venous anatomy before the procedure. Venous access was obtained through two separate punctures of the extrathoracic axillary vein using an 18 G puncture needle and a 0.025 glide wire. The vein was sequentially SelectSecure 3830 4F lead, and C315HIS sheath was used for LBBp. An additional loop was added to the ventricular lead to account for the growth of the patient. The primary outcomes were successful, stable LBBp. The secondary outcomes were lead stability over three months with no implant-related complications or death. RESULT: This case series has six patients of whom 2 were males and with a mean age of 9.5 years, and a mean body weight of 25.5 Kgs. All patients but one had undergone intracardiac repair (4 VSD, 1 ASD). The pacing indication was symptomatic AV block in five and sick sinus syndrome in one patient. At implant, the mean R wave was 12.83±4.8 mV, mean ventricular threshold was 0.6 ± 0.1 V at 0.5 ms pulse width, mean ventricular impedance of 737.3W ±131.5 ohms. The mean procedure time was 65± 20min, the mean fluoroscopy time was 14.63±13.3 min and the mean contrast volume was 30±20ml and the mean paced QRS duration was 98.5±16.5 ms and V5 LVAT 62.66±22.33ms. During follow follow-up of 4±3 months, the lead parameters were stable with a ventricular threshold of 0.8±0.1V at 0.5ms pulse width impedance of 689±130.2 ohms. There was no lead perforation, dislodgement, or death. CONCLUSION: LBBp in the pediatric population is feasible and safe with good -lead stability and no complications in the near term. [Figure: see text]