His bundle pacing in a young child guided by electroanatomical mapping
David Žižek1, Jernej Štublar1, Miha Weiss2
1Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
His bundle pacing offers a physiological alternative for pediatric patients with complete atrioventricular block, potentially preventing heart muscle damage from traditional pacing methods.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Device Technology
Background:
- Complete congenital atrioventricular (AV) block in children often necessitates lifelong right ventricular (RV) pacing.
- Standard RV pacing can lead to dyssynchronous ventricular activation and potentially pacing-induced cardiomyopathy.
- His bundle pacing (HBP) presents a more physiological alternative for ventricular activation.
Observation:
- A 5-year-old child with complete AV block underwent successful permanent His bundle pacing (HBP).
- A 3D electro-anatomical mapping system was utilized to guide the implantation and minimize fluoroscopy exposure.
- The procedure was completed without immediate complications.
Findings:
- Successful implantation of permanent His bundle pacing in a pediatric patient.
- Stable electrical parameters were observed during the short-term follow-up period.
- Reduced fluoroscopy time achieved through 3D electro-anatomical mapping.
Implications:
- His bundle pacing may be a viable and beneficial pacing strategy for pediatric patients with complete AV block.
- This approach could mitigate the risk of pacing-induced cardiomyopathy in young patients.
- Minimally invasive techniques like 3D mapping enhance procedural safety and efficiency in pediatric cardiac interventions.
Abstract:
Pediatric patients with complete congenital atrio-ventricular (AV) block are generally exposed to life-long dyssynchronous right ventricular (RV) pacing. His bundle pacing (HBP) is an alternative method of pacing that better restores physiological ventricular activation which could prevent pacing-induced cardiomyopathy. We present a case of a 5-year-old child with complete AV block who underwent successful permanent HBP implantation. Three-dimensional electro-anatomical mapping system was used to facilitate the procedure and reduce the fluoroscopy time. There were no acute procedure-related complications, and electrical parameters were stable at short-term follow-up.
