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Permanent conduction system pacing for congenitally corrected transposition of the great arteries: A Pediatric and Congenital Electrophysiology Society (PACES)/International Society for Adult Congenital Heart Disease (ISACHD) Collaborative Study

Permanent conduction system pacing for congenitally corrected transposition of the great arteries: A Pediatric and Congenital Electrophysiology Society (PACES)/International Society for Adult Congenital Heart Disease (ISACHD) Collaborative Study

Fecha de publicación: 01/06/2020 Fecha Ahead of Print: 13/03/2020

Autores de IIS La Fe

Óscar Cano Pérez

Autor

Participantes ajenos a IIS La Fe

Moore, JP
Gallotti, R
Shannon, KM
Pilcher, T
Vinocur, JM
Kean, A
Mondesert, B
Nurnberg, JH
Schaller, RD
Sharma, PS
Nishimura, T
Tung, R

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

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.

Datos de la publicación

ISSN/ISSNe:: 1547-5271, 1556-3871
Tipo:: Article
Páginas:: 991-997
DOI:: 10.1016/j.hrthm.2020.01.033
Factor de Impacto:: 2,768 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Keywords

Cardiac resynchronization therapy; Congenitally corrected transposition of the great arteries; His-bundle pacing; Left bundle branch pacing; Physiological pacing