[Effectiveness investigation on left bundle branch area pacing in 10 infants and toddlers]
1Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University, School of Clinical Medicine, Tsinghua University, Beijing 100016, China.
Insights
Left bundle branch area pacing (LBBAP) is a safe and effective treatment for bradyarrhythmia in young children. This study shows LBBAP achieves narrow QRS pacing and normal cardiac function in infants and toddlers.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Bradyarrhythmia in young children often requires permanent pacemaker implantation.
- Traditional pacing methods can lead to ventricular dyssynchrony and adverse cardiac remodeling.
- Left bundle branch area pacing (LBBAP) offers a potential solution for physiological pacing in pediatric populations.
Purpose of the Study:
- To evaluate the feasibility, safety, and effectiveness of LBBAP in children aged 3 years and younger.
- To assess the impact of LBBAP on QRS duration, cardiac function, and pacing parameters in this age group.
Main Methods:
- Retrospective analysis of 10 children (≤3 years) with bradyarrhythmia undergoing LBBAP.
- Data collected included intraoperative pacing parameters, electrocardiograms, cardiac ultrasound, and clinical follow-up.
- Preoperative and postoperative data were compared using matched samples t-test.
Main Results:
- LBBAP was successfully performed in all 10 children, with a mean age of 1.6 years.
- Postoperative QRS duration was narrowed to (100±9) ms, with 97% ventricular pacing.
- Significant reduction in left ventricular end-diastolic diameter Z-scores and preserved cardiac function (LVEF 66±4%) were observed post-LBBAP.
Conclusions:
- Left bundle branch area pacing is a safe and effective pacing strategy for infants and toddlers.
- LBBAP facilitates narrow QRS pacing, maintains stable pacing parameters, and supports normal cardiac function in young children.
- This technique shows promise for improving long-term outcomes in pediatric bradyarrhythmia.
Abstract:
Objective: To explore the feasibility, safety and effectiveness of left bundle branch area pacing (LBBAP) in children aged ≤3 years. Methods: A total of 10 children aged ≤3 years who were diagnosed with brady arrhythmia in the First Hospital of Tsinghua University from September 2020 to September 2021 were retrospectively analyzed. All the children met the indication of permanent pacemaker implantation and underwent LBBAP successfully. The intraoperative data (pacing parameters, electrocardiogram and radiographic imaging), cardiac ultrasound data and clinical data during regular postoperative follow-up were recorded. The preoperative and postoperative data were compared using matched samples t test. Results: Ten children (aged (1.6±0.7) years with weight of (10.3±2.5) kg) underwent LBBAP successfully. The QRS wave duration on the postoperative electrocardiogram was (100±9) ms, and the percentage of ventricular pacing was (97±7)%. The postoperative follow-up period was 6 (6, 12) months. At 1 week after operation, the left ventricular end-diastolic diameter Z scores in these children reduced significantly compared with those before operation (1.3±0.6 vs. 3.6±1.1, t=9.37, P<0.001). During the follow-up period, cardiac function was normal and the last left ventricular ejection fraction was (66±4)% in all children. At the last follow-up, the pacing threshold of the 10 children was smaller than 1.0 V and was acceptable. Compared with the intraoperative baseline values, the pacing threshold was slightly higher ((0.8±0.1) vs. (0.5±0.1) V, t=-5.27, P=0.001). However, no significant difference was found regarding sensing threshold ((16±5) vs. (14±4) mV, t=-0.83, P=0.426) and impedance ((584±88) vs. (652±86) Ω, t=2.26, P=0.050). During follow-up, no electrode related complications were recorded. Conclusions: LBBAP is safe and effective for infants and toddlers. Narrow QRS pacing with stable pacing parameters and normal cardiac function could be achieved postoperatively.
