[Clinical observation on six children of left bundle branch area pacing]
1Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Left bundle branch area pacing (LBBAP) is safe and effective in children, improving cardiac function and reducing left ventricular enlargement. This pediatric pacing method offers physiological benefits with stable parameters and quick recovery.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Right ventricular apical pacing (RVAP) can lead to cardiac dysfunction and enlargement in children.
- Alternative pacing strategies are needed to achieve more physiological cardiac pacing in pediatric patients.
- Left bundle branch area pacing (LBBAP) is an emerging technique for cardiac pacing.
Purpose of the Study:
- To evaluate the safety and effectiveness of left bundle branch area pacing (LBBAP) in pediatric patients.
- To assess the impact of LBBAP on cardiac function, left ventricular dimensions, and pacing parameters in children.
Main Methods:
- Retrospective analysis of 6 pediatric patients (9-14 years) who underwent permanent pacemaker implantation with LBBAP.
- Evaluation of clinical data, pacing electrocardiograms, and echocardiographic parameters before and after LBBAP.
- Assessment of pacing thresholds, sensing thresholds, impedance, and QRS duration.
Main Results:
- LBBAP achieved narrow QRS pacing with stable parameters (pacing threshold: 0.85±0.26 V, sensing: 15.0±4.3 mV, impedance: 717±72 Ω).
- No significant difference in QRS duration was observed post-LBBAP compared to pre-operation.
- LBBAP improved cardiac function in a patient with pre-existing dysfunction and reduced left ventricular end-diastolic diameter (LVEDD) Z-score (1.85±0.65 to 1.1±0.3).
Conclusions:
- Left bundle branch area pacing (LBBAP) is a safe and feasible pacing strategy for children, offering physiological benefits.
- LBBAP effectively improves cardiac dysfunction and reduces left ventricular enlargement associated with bradycardia or RVAP.
- Further long-term studies are needed to fully understand the potential risks of LBBAP in the pediatric population.
Abstract:
Objective: To explore the safety and effectiveness of left bundle branch area pacing (LBBAP) in children. Methods: Clinical data, pacing electrocardiogram and parameters of 6 patients (5 females and 1 male) who underwent permanent pacemaker implantation and LBBAP from January to June 2019 in the Department of Pediatric Cardiology of Anzhen Hospital were retrospectively analyzed. Results: The weight of the 6 patients aged between 9 and 14 years ranged from 26 to 48 kg. Five patients were diagnosed with third degree atrioventricular block, and 1 patient was diagnosed with cardiac dysfunction after right ventricular apical pacing. Cardiac function decreased in one patient and remained normal in the other five patients. Left ventricular end diastolic diameter (LVEDD) Z score was 1.85±0.65. V(1) lead showed changes like right bundle branch block in pacing electrocardiogram. No significant difference was found regarding QRS wave duration ((95±13) ms vs. (111±20) ms, t=-1.610, P>0.05) between preoperation and postoperation. Pacing threshold was (0.85±0.26) V. The sensing threshold was (15.0±4.3) mV and the impedance was (717±72) Ω. P potential was recorded in 3 cases. The earliest left ventricular local activation time was (56±5) ms and remained stable at different output voltages. Postoperative echocardiography revealed that the electrodes were located near the endocardium of the left ventricular septum. No complications such as myocardial perforation and electrode dislocation occurred during follow-up. The pacing threshold, sensing threshold and impedance were (0.60±0.09)V, (16.1±3.9)mV, (662±78)Ω respectively at 3 months after operation. The patient with low left ventricular ejection fraction (LVEF) recovered to normal on the 3 rd day after LBBAP (45% vs. 57%). The LVEDD Z score decreased to (1.1±0.3) at 3 months after operation and was significantly lower than that before operation (t=2.38, P<0.05). Conclusions: LBBAP in children can achieve narrow QRS pacing andphysiological pacing with stablepacing parameters. It can improve left ventricular enlargement caused by long-term bradycardia, and cardiac dysfunction and cardiac enlargement caused by long-term right ventricular apical pacing quickly and effectively.LBBAP is safe and feasible for older children in the near future. However, the long term potential risks of LBBAP need further observation and study.
Related Concept Videos
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for: