Conduction System Pacing in Pediatric Patients: Outcomes From a Multicenter International Cohort

Conduction system pacing (CSP) may be advantageous in children requiring lifelong ventricular pacing, but long-term durability data are limited.

The goal of this study was to evaluate the long-term preservation, durability, and safety of CSP in pediatric patients.

This international, multicenter, retrospective study included consecutive patients aged ≤18 years undergoing His bundle pacing or left bundle branch area pacing at 9 experienced centers. The primary endpoint was long-term preservation of CSP.

Among 120 patients (mean age 12.6 ± 3.7 years), 68 (56.7%) had congenital atrioventricular block, 41 (34.2%) had congenital heart disease, and 12 (10.0%) underwent CSP for heart failure/cardiac resynchronization therapy (CRT). Acute CSP implantation, defined as achievement of His bundle pacing, left bundle branch pacing, or left ventricular septal pacing, was successful in 116 patients (96.7%). After a median follow-up of 24 months (Q1-Q3: 10-54 months), electrical lead performance remained stable. Among 101 patients with CSP at implantation and follow-up capture assessment, CSP was preserved in 95 (94.1%). Kaplan-Meier-estimated freedom from loss of CSP was 100.0% at 1 year and 98.2% (95% CI: 94.7%-100.0%) at 2 and 3 years. CSP lead-related complications occurred in 10 patients (8.3%), and reintervention was required in 9 (7.5%). In the CRT subgroup, left ventricular ejection fraction improved from 28.8% ± 9.4% to 46.8% ± 12.0% (P < 0.001).

CSP is a feasible, safe, and durable physiological pacing strategy in children, with excellent long-term CSP preservation and stable electrical performance despite ongoing somatic growth. CSP may also provide effective physiological resynchronization in pediatric patients requiring CRT.