Left bundle branch area pacing in pediatric patients as an effective and safe method of surgical treatment of atrioventricular block: case series

Aim. To present the experience of surgical treatment of atrioventricular block by endocardial left bundle branch area pacing and to describe the clinical follow-up of 12 pediatric patients at the Republican Scientific and Practical Center for Pediatric Surgery.

Materials and Methods. This article reports the experience of permanent pacemaker implantation with a ventricular lead placed in the left bundle branch area in 12 pediatric patients with atrioventricular block. The mean age was 12.67 ± 3.27 years old, the mean weight was 48.64 ± 15.83 kg. The mean follow-up period was 10.58 ± 4.89 months (3 – 18 months). Before and after the surgical intervention, the QRS complex duration and a number of echocardiographic parameters were measured. Standard pacing parameters were also assessed during the implantation and after 3 months. The presence of peri- and postoperative complications was evaluated.

Results. Successful left bundle branch area pacing was achieved in all 12 patients. In all cases the criteria for left bundle branch capture were recorded: the paced QRS displayed the pattern of the right bundle branch block in lead V1, mean V6 RWPT = 55,17 ± 8,87 ms, IPT V1-V6 = 43,50 ± 6,5 ms. Optimal and stable pacing parameters on the ventricular lead were noted during implantation and at the 3-month follow-up visit (mean threshold at 3 months: 0.54 ± 0.1 V; mean sensitivity: 13.33 ± 3.45 mV; mean impedance: 493.25 ± 92.12 Ohm). The paced QRS complex demonstrated physiological contraction of both ventricles (the mean duration of the paced QRS complex was 100.67 ± 11.14 ms). During the postoperative follow-up period, left ventricular dimensions and ejection fraction did not change significantly. No implantation-related complications occurred in the perioperative period.

Conclusion. Left bundle branch area pacing can be considered an effective and safe method of surgical treatment of atrioventricular block in pediatric patients, providing optimal pacing parameters, physiological ventricular contraction and potential prevention of pacemaker-induced cardiomyopathy, which necessitates further long-term observation.

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