Jeremy P Moore1, Roberto Gallotti2, Kevin M Shannon2, Thomas Pilcher3, Jeffrey M Vinocur4, Óscar Cano5, Adam Kean6, Blandine Mondesert7, Jan-Hendrik Nürnberg8, Robert D Schaller9, Parikshit S Sharma10, Takuro Nishimura11, Roderick Tung11. 1. Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California. Electronic address: jpmoore@mednet.ucla.edu. 2. Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California. 3. University of Utah, Primary Children's Hospital, Salt Lake City, Utah. 4. University of Rochester, Rochester, New York. 5. Hospital Universitario y Politécnico La Fe and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain. 6. Riley Hospital for Children, Indianapolis, Indiana. 7. Montreal Heart Institute, Montreal, Quebec, Canada. 8. Elektrophysiologie Bremen, Bremen, Germany. 9. University of Pennsylvania, Philadelphia, Pennsylvania. 10. Rush University Medical Center, Center for Arrhythmia Care, Chicago, Illinois. 11. University of Chicago Medicine, Chicago, Illinois.
Abstract
BACKGROUND: Congenitally corrected transposition of the great arteries (CCTGA) is associated with spontaneous atrioventricular block and pacing-induced cardiomyopathy. Conduction system pacing is a potential alternative to conventional cardiac resynchronization therapy (CRT). OBJECTIVE: The purpose of this study was to determine the outcomes of conduction system pacing for CCTGA. METHODS: Retrospective data were collected from 10 international centers. RESULTS: His bundle (HBP) or left bundle branch pacing (LBBP) was attempted in 15 CCTGA patients (median age 23 years; 87% male). Previous surgery had been performed in 8 and chronic ventricular pacing in 7. Conduction system pacing (11 HBP, 2 LBBP 2; nonselective in 10, selective in 3) was acutely successful in 13 (86%) without complication. In 9 cases, electroanatomic mapping was available and identified the distal His bundle and proximal left bundle branches within the morphologic left ventricle below the pulmonary valve separate from the mitral annulus. Median implant HV interval was 42 ms (interquartile range [IQR] 35-48), R wave 6 mV (IQR 5-18), and threshold 0.5 V (IQR 0.5-1.2) at median 0.5 ms. QRSd was unchanged compared to junctional escape rhythm (124 vs 110 ms; P = .17) and decreased significantly compared to baseline ventricular pacing (112 vs 164 ms; P <.01). At a median of 8 months, all patients were alive without significant change in pacing threshold or lead dysfunction. New York Heart Association functional class improved in 5 patients. CONCLUSION: Permanent conduction system pacing is feasible in CCTGA by either HBP or proximal LBBP. Narrow paced QRS and stable lead thresholds were observed at intermediate follow-up. Unique anatomic characteristics may favor this approach over conventional CRT. Published by Elsevier Inc.
BACKGROUND: Congenitally corrected transposition of the great arteries (CCTGA) is associated with spontaneous atrioventricular block and pacing-induced cardiomyopathy. Conduction system pacing is a potential alternative to conventional cardiac resynchronization therapy (CRT). OBJECTIVE: The purpose of this study was to determine the outcomes of conduction system pacing for CCTGA. METHODS: Retrospective data were collected from 10 international centers. RESULTS:His bundle (HBP) or left bundle branch pacing (LBBP) was attempted in 15 CCTGA patients (median age 23 years; 87% male). Previous surgery had been performed in 8 and chronic ventricular pacing in 7. Conduction system pacing (11 HBP, 2 LBBP 2; nonselective in 10, selective in 3) was acutely successful in 13 (86%) without complication. In 9 cases, electroanatomic mapping was available and identified the distal His bundle and proximal left bundle branches within the morphologic left ventricle below the pulmonary valve separate from the mitral annulus. Median implant HV interval was 42 ms (interquartile range [IQR] 35-48), R wave 6 mV (IQR 5-18), and threshold 0.5 V (IQR 0.5-1.2) at median 0.5 ms. QRSd was unchanged compared to junctional escape rhythm (124 vs 110 ms; P = .17) and decreased significantly compared to baseline ventricular pacing (112 vs 164 ms; P <.01). At a median of 8 months, all patients were alive without significant change in pacing threshold or lead dysfunction. New York Heart Association functional class improved in 5 patients. CONCLUSION: Permanent conduction system pacing is feasible in CCTGA by either HBP or proximal LBBP. Narrow paced QRS and stable lead thresholds were observed at intermediate follow-up. Unique anatomic characteristics may favor this approach over conventional CRT. Published by Elsevier Inc.
Entities:
Keywords:
Cardiac resynchronization therapy; Congenitally corrected transposition of the great arteries; His-bundle pacing; Left bundle branch pacing; Physiological pacing
Authors: Marieke Nederend; Monique R M Jongbloed; Philippine Kiès; Hubert W Vliegen; Berto J Bouma; Madelien V Regeer; Dave R Koolbergen; Mark G Hazekamp; Martin J Schalij; Anastasia D Egorova Journal: Front Cardiovasc Med Date: 2022-05-10