First experience of His bundle pacing in pediatric patients

Abstract

Aim. To present our clinic’s experience of His bundle pacing in pediatric patients.Methods. Six patients underwent endocardial pacemaker implantation with a ventricular lead in the Hisian position. A standard diagnostic examination was carried out, including routine general clinical and laboratory examinations, an ECG with an assessment of QRS width, Holter monitoring, echocardiography (Echo) with an assessment of the sizes, volumes of the heart chambers, left ventricle (LV) contractile function and Speckle-tracking Echo with an assessment of LV global longitudinal strain (LV GLS). To assess dynamic control ECG, Holter monitoring, Echo and Speckle-tracking Echo were performed.Results. Selective His bundle pacing (isolated capture of the His-Purkinje system) was achieved in only one patient; non-selective His bundle pacing was performed in the remaining 5 patients. With His bundle selective and non-selective pacing, a significant normalization of the LV electromechanical dyssynchrony index (GLS) was noted from -17 [-15; -19] to -21.4 [-21;-22] (p = 0.013). The most significant normalization of LV longitudinal strain was recorded in a patient with previous epicardial stimulation of the right ventricle (RV).Conclusion. Physiological His bundle pacing favours ventricular synchronization, providing the most physiological myocardium pacing, both during primary pacemaker implantation and in patients with previous long-term RV pacing, accompanied by ventricular dyssynchrony.