His Bundle and Left Bundle Pacing in Pediatrics and Congenital Heart Disease: A Single Center Experience
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ORIGINAL ARTICLE
His Bundle and Left Bundle Pacing in Pediatrics and Congenital Heart Disease: A Single Center Experience Erick Jimenez1 · Nicholas Zaban2 · Nandita Sharma1 · Shanti Narasimhan1 · Chip Martin‑Chafee2 · Jamie L. Lohr1 · Daniel Cortez1,3 Received: 6 April 2020 / Accepted: 12 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Pediatric · His bundle pacing · Congenital heart disease
Introduction Pacing in the pediatric population requires thoughtful considerations regarding type of pacing, the consequences of long-term pacing, and how to best implement pacing. Longterm right ventricular pacing is associated with left ventricular dysfunction and cardiomyopathy in up to 13% of the cases with this type of pacing [1, 2]. Pediatric patients and those with congenital heart disease (CHD) are especially vulnerable to left ventricular dysfunction with chronic right ventricular pacing [3, 4]. His bundle pacing has been * Daniel Cortez [email protected] 1
Pediatric Cardiology, University of Minnesota/Masonic Children’s Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN 55454, USA
2
Pediatric Cardiology, CentraCare Heart and Vascular Center, Saint Cloud, USA
3
Clinical Sciences, Lunds Universitet, Lund, Sweden
demonstrated to be feasible in adults that require long-term pacing, however, higher pacing threshold for His bundle capture, and high dislodgement rate have been important considerations [5]. Cardiac resynchroniz
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