CONGRESS ABSTRACT

Background : Left Bundle Branch Area Pacing (LBBAP) has become over the last years a promising pacing strategy by avoiding the desynchronization of the left ventricle. Many data confirm the safety and the clinical performance of this technique in adult patients with indication for pacing. On the contrary, only few case series have been reported about LBBAP in children and in GUCH patients. Methods : We report successful implantation of LBBAP in eight consecutive patients (4 children and 4 GUCH patients) and their further follow-up. A written informed consent was obtained before the procedure. The procedures performed in children were undertaken under general anaesthesia. Results : Four pediatric patients met indication for permanent pacing (2 Male, mean age at implant 11,4 years). Three of them had a structural normal heart and underwent pacemaker implantation because because of symptomatic complete atrio-ventricular block (AVB). The fourth patient, an 8-year-old male who underwent urgent single lead pacemaker implantation for complete AVB in another centre, developed a severe biventricular disfunction. Due to worsening heart failure, he was referred to our centre and he underwent up-grading to CRT-P; coronary sinus was impossible to cannulate so we performed LBBAP as bail-out strategy after failure of biventricular pacing. Four GUCH patients (two patients with atrioventricular canal, two with coronary artery anomalies), underwent pacemaker implantation, three because of complete AV block, one because of atrial fibrillation with low ventricular rate. In these eight patients we used a Medtronic Select Secure (Model 3830) lumenless lead, all implanted via left axillary or subclavian vein puncture in the interventricular septum in the region of the left bundle branch. Electrical parameters at implant (R-wave peak time in V6; V6-V1 interpeak interval) confirmed the capture of the conduction system. There were no adverse events neither at implantation nor during follow up, and the electrical parameters of the right ventricular lead remained stable. Conclusions : LBBAP is a promising and safe pacing strategy also in the pediatric and GUCH populations, both for patients with complete AV block and a prediction of 100% ventricular pacing and for patients in whom resynchronisation therapy is not feasible. One concern, particularly in children, may be the performance of LBBAP during the growth of the patients and of its conduction system.