Three-dimensional mapping for His-bundle pacing in pediatric patients, a case series

Area of Science:

• Cardiology
• Pediatric Electrophysiology
• Medical Device Technology

Background:

• Pediatric pacemaker recipients face lifelong risks from repeated fluoroscopy exposure.
• His bundle pacing presents a potential alternative for improved long-term pacing in pediatric populations.
• Minimizing radiation exposure is crucial for young patients undergoing cardiac procedures.

Purpose of the Study:

• To evaluate the feasibility and short-term efficacy of His bundle pacing guided by 3D electroanatomic mapping in pediatric patients.
• To assess the potential of this technique to reduce fluoroscopy time and radiation dose.
• To determine the safety and effectiveness of His bundle pacing in a pediatric cohort, including those with complex congenital heart defects.

Main Methods:

• Utilized an Octapolar Livewire catheter for His bundle mapping and localization.
• Employed the EnSite Precision 3D mapping system to create patient-specific cardiac geometry.
• Recorded His bundle signal strengths and ventricular activation times using the 3D mapping system.

Main Results:

• Successfully implemented selective His bundle pacing in three pediatric patients (ages 10-15).
• Achieved significantly reduced fluoroscopy times (6.4-9.9 minutes) and radiation doses (5.64-10.18 mGy).
• Demonstrated stable lead performance (thresholds, impedances, sensing) at 4-5 months follow-up.

Conclusions:

• His bundle pacing guided by 3D mapping is a successful and safe short-term strategy for pediatric patients.
• This approach is effective even in pediatric patients with altered His bundle physiology, such as those with atrioventricular canal defects.
• The technique offers a valuable method to minimize fluoroscopy exposure in young individuals requiring pacemakers.