Pediatric Pacing from Proximal Right Ventricular Septum: Preserved Left Ventricular Systolic Function at Follow-Up

Area of Science:

• Cardiology
• Pediatric Electrophysiology
• Medical Imaging

Background:

• Chronic right ventricular (RV) pacing can negatively impact left ventricular (LV) function.
• Non-fluoroscopic 3D-electroanatomic mapping (3D-EAM) enables precise catheter placement, reducing radiation exposure.
• Pediatric patients with complete atrioventricular block (CAVB) often require pacing, necessitating methods to preserve cardiac function.

Purpose of the Study:

• To assess if 3D-EAM-guided pacing of the proximal RV septum (RVS) maintains LV contractility in pediatric patients with CAVB.
• To compare LV function outcomes between RVS pacing and non-selective His bundle pacing (NSHBP).

Main Methods:

• Retrospective, single-center study analyzing electrocardiograms and echocardiograms from 61 pediatric patients.
• Evaluation of QRS duration, LV dimensions, ejection fraction (EF), global longitudinal/circumferential strain (GLS/GCS), and rotation.
• Comparison of outcomes between NSHBP (n=9) and RVS (n=48) pacing groups over a median follow-up of 4 years.

Main Results:

• Paced QRS duration remained stable at 118 ms across all patients.
• No significant differences in QRS duration or LV systolic function were found between NSHBP and RVS groups.
• LV systolic function was largely preserved, with improvements noted in patients with baseline dysfunction; lead complications were less frequent with RVS pacing.

Conclusions:

• 3D-EAM-guided proximal RVS pacing effectively preserves LV systolic function in pediatric patients with CAVB.
• This pacing strategy demonstrates safety and efficacy, with fewer lead-related issues compared to NSHBP.
• Proximal RVS pacing is a viable option for maintaining cardiac function in pediatric patients requiring permanent pacing.