Feasibility and safety of permanent left bundle branch area pacing in pediatric patients

Abstract Introduction Left bundle branch area pacing (LBBAP) is a promising pacing strategy with a low and stable pacing threshold. It maintains electrical and mechanical synchronization of the ventricles. Conduction system pacing (CSP) has evolved rapidly to become the pacing method of choice for many adult and pediatric patients. Recent studies have begun to demonstrate the feasibility and efficacy of CSP in pediatric patients. Nowadays, research articles about LBBAP in children are comparatively rare, therefore, research in this area is preferred. Limited data on LBBAP in pediatric patients (≤ 18 years old) are available. Purpose This study aims to describe the feasibility and safety of LBBAP in pediatric patients. Methods This study includes 4 patients: 1 male, and 3 females, respectively. The average age of the patients was 15.5±1.9 years and the weight was 51,5±17,6 kg. All patients were diagnosed with 3rd-degree atrioventricular (AV) block, in one case the total AV block occurred after previous radiofrequency ablation of the parahisian and right lateral accessory pathway. One patient had previously been implanted with an epicardial pacemaker and presented to our clinic with ventricular lead dysfunction. Pacing parameters were assessed during implantation, the next day after the procedure, and 1, 3 months follow-up. Echocardiography was performed to evaluate LV function and assess the approximate lead location and impact on tricuspid valve function. Results LBBAP was successfully achieved in all patients resulting in narrow QRS complexes (102±12.7ms) and right bundle branch block QRS morphology. To confirm left bundle branch area capture, peak left ventricular activation time (pLVAT) (84.5±4.1ms), V6-V1 (43.5±2.5ms) inter-peak interval, presence of left bundle potential, transition from non-selective to selective capture were recorded at during the implantation. The mean paced QRS duration was (108±13 ms). Pacing threshold and impedance remain stable (0.75±0.25V, and 615±50 Ohm, respectively). There was no major complication during the implanting process and follow-up. Conclusions LBBAP can be performed safely in children with narrow QRS complexes and can achieve stable pacing parameters.