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Conduction System Pacing in Children and Congenital Heart Disease

Óscar Cano1,2, Jeremy P Moore3,4,5

  • 1Hospital Universitari i Politècnic La Fe Valencia, Spain.

Arrhythmia & Electrophysiology Review
|November 26, 2024
PubMed

Insights

Conduction system pacing (CSP) offers a new approach for children with congenital heart conditions, potentially preventing heart muscle damage from traditional pacing methods. This review explores CSP techniques and evidence for its use in congenital complete atrioventricular block and congenital heart disease.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Cardiovascular Research

Background:

  • Permanent cardiac pacing in children with congenital complete atrioventricular block (CCAVB) and congenital heart disease (CHD) presents unique challenges.
  • Conventional right ventricular pacing can lead to pacing-induced cardiomyopathy in these high-risk patients.
  • Preserving physiological ventricular activation is crucial for long-term outcomes.

Purpose of the Study:

  • To review the implantation techniques for conduction system pacing (CSP) in pediatric patients.
  • To summarize the current clinical evidence supporting CSP in CCAVB and CHD.
  • To discuss future directions for CSP in this specific population.

Main Methods:

  • Literature review of studies on conduction system pacing in pediatric populations.
  • Analysis of implantation techniques, including His-bundle pacing and left bundle branch area pacing.
  • Synthesis of clinical outcomes data from existing studies.

Main Results:

  • CSP aims to mimic natural cardiac conduction, preserving ventricular synchrony.
  • Early evidence suggests CSP may reduce the risk of pacing-induced cardiomyopathy compared to RV pacing.
  • Successful implantation techniques are evolving, with increasing adoption in pediatric centers.

Conclusions:

  • Conduction system pacing is a promising alternative to conventional pacing in children with CCAVB and CHD.
  • CSP may offer significant benefits by preventing ventricular dyssynchrony and subsequent cardiomyopathy.
  • Further research and larger trials are needed to establish long-term efficacy and safety.

Keywords:
CHDConduction system pacingHis bundle pacingcongenital complete atrioventricular blockleft bundle branch area pacing

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