A Study to Analyse the Feasibility and Effectiveness of Left Bundle Branch Area Pacing Used in Young Children
Jinghao Li1,2, He Jiang1,2, Yi Zhang1
1Department of Paediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), No.6, Jiuxianqiao 1st Road, Chaoyang, Beijing, 100016, China.
Insights
Left bundle branch area pacing (LBBaP) is a feasible and effective pacing method for young children with complete atrioventricular block. This study found LBBaP resulted in narrower QRS durations and improved cardiac function compared to traditional pacing.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Complete atrioventricular block in children often necessitates permanent pacing.
- Traditional right ventricular pacing can lead to suboptimal ventricular synchrony and increased QRS duration.
- Left bundle branch area pacing (LBBaP) offers a potential alternative for more physiological ventricular activation.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of LBBaP in pediatric patients.
- To compare pacing parameters, cardiac function, and synchrony between LBBaP and right ventricular septal pacing (RVSP).
Main Methods:
- A prospective study included 31 children (≤7 years) with complete atrioventricular block undergoing LBBaP.
- Pacing parameters, QRS duration, and echocardiographic parameters (including LVEF) were assessed.
- Follow-up included evaluation of pacing thresholds and cardiac function.
Main Results:
- LBBaP was successfully implemented in 70.9% of cases.
- The LBBaP group exhibited significantly narrower postoperative QRS durations (100.9 ms) compared to the RVSP group (114.2 ms).
- Lower ventricular capture thresholds and better left ventricular ejection fraction were observed in the LBBaP group at follow-up.
Conclusions:
- Left bundle branch area pacing is a safe and effective pacing strategy for young children.
- LBBaP provides satisfactory pacing parameters and achieves narrower QRS durations, suggesting improved cardiac synchrony.
- LBBaP demonstrates advantages over RVSP in terms of electrical parameters and cardiac function in pediatric patients.
Abstract:
This study aimed to investigate the feasibility and effectiveness of left bundle branch area pacing (LBBaP) in young children. From September 2020 to May 2021, a total of 31 children (≤ 7 years) with complete atrioventricular block were included. All patients were scheduled to undergo LBBaP. Pacing parameters, and cardiac function and synchrony were evaluated during follow-up. LBBaP succeeded in 21 children (3.3 ± 2.1 years old), with a success rate of 70.9%. LBBaP failed in nine children, who eventually received right ventricular septal pacing (RVSP). The average postoperative QRS duration in patients of LBBaP group was narrower than that of RVSP group: 100.9 ± 9.1 versus 114.2 ± 11.9 ms (P = 0.002). The median follow-up duration was 12 [interquartile range (IQR) 6-15] months. At last time of follow-up, the capture threshold of ventricular electrode in patients of LBBaP group were significantly lower than that of RVSP group (0.70 ± 0.25 versus 1.39 ± 0.94 V, P = 0.011). The echo-left ventricular ejection fraction (LVEF) in patients in the LBBaP group was better than that in the RVSP group (66.1 ± 3.3 versus 63.1 ± 2.2%, P = 0.025). LBBaP can be safely and effectively administered in young children. Satisfactory pacing parameters, and narrow QRS durations were obtained.
