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