Left bundle branch area pacing in children: case series

Background: Left bundle branch area pacing (LBBAP) is a new concept that provides physiological pacing with a narrow QRS duration. Recently published data suggest that LBBAP may prevent deleterious effects of right ventricular pacing, namely pacemaker-induced cardiomyopathy, especially in patients with expected high ventricular pacing burden, which may be of particular importance in children. Case summary: Herein, we report successful implantation of Medtronic SelectSecure (Model 3830, Medtronic Inc.) right ventricle electrode in the region of left bundle branch area in three consecutive children (two 16-year-old and one 8-year-old). Indication for pacemaker implantation was third-degree atrioventricular block in all cases. Implantations were performed under general anaesthesia, and there were no acute complications. During the median follow-up of 6 months, there were no adverse events and the electrical parameters of the device remained stable. Discussion: Compared with adult patients, implantation of pacemakers in children may still be challenging, not only because of smaller body size but also due to continuing growth and a higher rate of lead and device-related complications. We have demonstrated that implantation of LBBAP in children is feasible and could be worth considering, particularly in patients with expected high ventricular pacing burden. Further studies are needed to assess the efficacy and safety of LBBAP in children during long-term observation.