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Scott M, Needleman JS, Kean AC. Conduction System Pacing in Pediatrics and Congenital Heart Disease: A Case Report and Literature Review. J Innov Card Rhythm Manag 2024; 15:5749-5755. [PMID: 38444449 PMCID: PMC10911636 DOI: 10.19102/icrm.2024.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/28/2023] [Indexed: 03/07/2024] Open
Abstract
Conduction system pacing involving either His bundle pacing (HBP) or left bundle branch pacing (LBBP) is a modality that has been introduced as a safe and effective alternative to right ventricular (RV) pacing to help prevent pacemaker-associated cardiomyopathy. While HBP has been employed in the pediatric and congenital populations, several small studies have shown LBBP to be safe and effective in the pediatric population. We present a patient with congenital atrioventricular block and postoperative ventricular septal defect repair cardiomyopathy with subsequent left ventricular function improvement following a transition from an RV epicardial pacemaker system to an LBBP system. This case report serves as a foundation for a review of the current state of LBBP in pediatrics and congenital heart disease.
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Affiliation(s)
- Michael Scott
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph S. Needleman
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University, School of Medicine, Atlanta, GA, USA
| | - Adam C. Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Ploneda Valencia RG, Levinstein Jacinto M, Sánchez Contreras CA, Ruiz González G, Neach de la Vega D, Márquez Murillo MF, Nava S. Case report: Challenges and implications of conduction system pacing in pediatrics: Case series. Front Pediatr 2023; 11:1160335. [PMID: 37215597 PMCID: PMC10192706 DOI: 10.3389/fped.2023.1160335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Cardiac electrical stimulation in children usually is needed in the setting of complete congenital atrioventricular block, atrioventricular block after heart surgery, and bradycardia associated with some specific channelopathies. In cases of atrioventricular block, the high percentage of ventricular stimulation raises concern on the deleterious effects of chronic stimulation of the right ventricle. In recent years, physiologic stimulation has developed as a valid approach for adult patients and a great interest has risen in offering conduction system pacing also to the pediatric population. We present three pediatric cases of stimulation of the conduction system (His bundle or left bundle branch), in order to show the intrinsic particularities and challenges implied in these new techniques.
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3
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Chubb H, Mah D, Dubin AM, Moore J. Conduction system pacing in pediatric and congenital heart disease. Front Physiol 2023; 14:1154629. [PMID: 37035676 PMCID: PMC10080025 DOI: 10.3389/fphys.2023.1154629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Conduction system pacing (CSP) has evolved rapidly to become the pacing method of choice for many adults with structurally normal hearts. Studies in this population have repeatedly demonstrated superior hemodynamics and outcomes compared to conventional pacing with the recruitment of the native conduction system. Children and patients with congenital heart disease (CHD) are also likely to benefit from CSP but were excluded from original trials. However, very recent studies have begun to demonstrate the feasibility and efficacy of CSP in these patients, with growing evidence that some outcomes may be superior in comparison to conventional pacing techniques. Concerns regarding the technical challenges and long-term lead parameters of His Bundle Pacing (HBP) have been overcome to many extents with the development of Left Bundle Branch Area Pacing (LBBAP), and both techniques are likely to play an important role in pediatric and CHD pacing in the future. This review aims to assimilate the latest developments in CSP and its application in children and CHD patients.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
- *Correspondence: Henry Chubb,
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Jeremy Moore
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, United States
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, United States
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Hua J, Xiong Q, Xia Z, Huang Q, Huang L, Xia Z, Hu J, Li J, Hu J, Chen Q, Hong K. Permanent Left Bundle Branch Area Pacing for High-Degree Atrioventricular Block in a 6-Year-Old Child with 2-Year Follow-Up. Int Heart J 2022; 63:957-962. [DOI: 10.1536/ihj.22-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Juan Hua
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Qinmei Xiong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Zhen Xia
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Qianghui Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Lin Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Zirong Xia
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Jianxin Hu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Juxiang Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Jinzhu Hu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Qi Chen
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Kui Hong
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang University
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Cohen MI. Inadvertent LBBB Pacing: Landing on the Right (Left) Spot. JACC Case Rep 2021; 3:1736-1737. [PMID: 34825199 PMCID: PMC8603043 DOI: 10.1016/j.jaccas.2021.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mitchell I. Cohen
- Division of Pediatric Cardiology, Inova LJ Murphy Children’s Hospital, Falls Church, Virginia, USA
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Dandamudi G, Simon J, Cano O, Master V, Koruth JS, Naperkowski A, Kean AC, Schaller R, Ellenbogen KA, Kron J, Vijayaraman P. Permanent His Bundle Pacing in Patients With Congenital Complete Heart Block: A Multicenter Experience. JACC Clin Electrophysiol 2020; 7:522-529. [PMID: 33358665 DOI: 10.1016/j.jacep.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). BACKGROUND HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. METHODS Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. RESULTS Patients' mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. CONCLUSIONS HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
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Affiliation(s)
- Gopi Dandamudi
- Division of Cardiology, CHI Franciscan, Tacoma, Washington, USA; Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Joel Simon
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Oscar Cano
- Division of Cardiology, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Vivak Master
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jacob S Koruth
- Division of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Angela Naperkowski
- Division of Cardiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
| | - Adam C Kean
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert Schaller
- Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordana Kron
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
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Jimenez E, Zaban N, Sharma N, Narasimhan S, Martin-Chafee C, Lohr JL, Cortez D. His Bundle and Left Bundle Pacing in Pediatrics and Congenital Heart Disease: A Single Center Experience. Pediatr Cardiol 2020; 41:1425-1431. [PMID: 32567011 DOI: 10.1007/s00246-020-02398-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
Long-term right ventricular pacing is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatric patients and those with congenital heart disease (CHD). Research has shown that pacing-induced cardiomyopathy can be reversed with nonselective or selective His bundle pacing in adults, however, the information available about the use of this type of therapy in pediatrics and CHD is scarce. We performed a retrospective chart review of all the cases of His or left bundle pacing at the University of Minnesota, division of Pediatric Cardiology from January of 2019 to April of 2020. Parametric data are presented as mean ± standard deviation. Non-parametric data are presented as median value with interquartile ranges. Eight patients, ages 8 to 18 years (median of 11.5) and weight from 21.5 to 81.6 kg (median of 40 kg) underwent this procedure successfully. The most common structural heart disease was a repaired peri-membranous ventricular septal defect. Three patients (37.5%) had selective and three (37.5%) had nonselective His bundle pacing, and two patients (25%) had left bundle pacing. There were two cases of pacing-induced cardiomyopathy and each had a 14% and 16% improvement of the ejection fraction after nonselective His bundle pacing. There were no procedural complications. Selective and nonselective His bundle, as well as left bundle pacing may be a feasible procedure in pediatric patients with and without CHD. This procedure may improve pacing-induced cardiomyopathy in this population.
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Affiliation(s)
- Erick Jimenez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Nicholas Zaban
- Pediatric Cardiology, CentraCare Heart and Vascular Center, Saint Cloud, USA
| | - Nandita Sharma
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Shanti Narasimhan
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Chip Martin-Chafee
- Pediatric Cardiology, CentraCare Heart and Vascular Center, Saint Cloud, USA
| | - Jamie L Lohr
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Daniel Cortez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA.
- Clinical Sciences, Lunds Universitet, Lund, Sweden.
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Ponnusamy SS, Arora V, Namboodiri N, Kumar V, Kapoor A, Vijayaraman P. Left bundle branch pacing: A comprehensive review. J Cardiovasc Electrophysiol 2020; 31:2462-2473. [DOI: 10.1111/jce.14681] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/27/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Vanita Arora
- Department of Cardiology Max Healthcare Super Speciality Hospital New Delhi India
| | - Narayanan Namboodiri
- Department of Cardiology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Vivek Kumar
- Department of Cardiology Max Healthcare Super Speciality Hospital New Delhi India
| | - Aditya Kapoor
- Department of Cardiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute Geisinger Commonwealth School of Medicine, Geisinger Heart Institute Wilkes‐Barre Pennsylvania USA
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Huang J, Zhou R, Pan Y, Yang B. Permanent left bundle branch area pacing in a child with a third-degree atrioventricular block: A case report. J Cardiovasc Electrophysiol 2020; 31:1539-1543. [PMID: 32337777 DOI: 10.1111/jce.14520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
Permanent left bundle branch area pacing (LBBP) is a promising physiological pacing technique that has emerged in recent years. However, LBBP is almost exclusively clinically applied in adult patients. The feasibility and safety of the use of LBBP in children have not been well-assessed. Here, we report the case of a 6-year-old child with a third-degree atrioventricular block after surgical aortic valve replacement who successfully received a permanent LBBP.
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Affiliation(s)
- Jing Huang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Runze Zhou
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yesheng Pan
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
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Zhang L, Cheng X, Chen J, Zhou M, Qian T, Zhang Z, Yin J, Zhang H, Dai G, Qin Y, Yang S. Left Bundle Pacing for Left Bundle Branch Block and Intermittent Third-Degree Atrioventricular Block in a MYH7 Mutation-Related Hypertrophic Cardiomyopathy With Restrictive Phenotype in a Child. Front Pediatr 2020; 8:312. [PMID: 32612965 PMCID: PMC7308432 DOI: 10.3389/fped.2020.00312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a group of myocardial diseases defined by cardiac hypertrophy which cannot be explained by secondary causes with a non-dilated left ventricle and preserved or increased ejection fraction. Sometimes it can be combined with restrictive cardiomyopathy. Here we describe a very rare case of a 12-year-old girl with non-obstructive hypertrophic cardiomyopathy accompanied by restrictive phenotype, complete left bundle branch block and intermittent third-degree atrioventricular block, who presented with recurrent syncope. Her father was also found to have hypertrophic cardiomyopathy and treated with implantable cardioverter defibrillator for ventricular tachycardia. Her younger brother is currently asymptomatic but echocardiogram showed hypertrophic cardiomyopathy. Genetic analysis identified a heterozygous missense mutation (c.2155C>T, p.R719W) of MYH7 in the proband girl, her father and her brother. The girl was treated with left bundle pacing and recovered well. The case we present further demonstrates the feasibility of left bundle pacing in children.
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Affiliation(s)
- Luyan Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Cheng
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Zhou
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Tianwei Qian
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongman Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Yin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Han Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Genyin Dai
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuming Qin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
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