TY - JOUR
T1 - Permanent conduction system pacing for congenitally corrected transposition of the great arteries
T2 - A Pediatric and Congenital Electrophysiology Society (PACES)/International Society for Adult Congenital Heart Disease (ISACHD) Collaborative Study
AU - Moore, Jeremy P.
AU - Gallotti, Roberto
AU - Shannon, Kevin M.
AU - Pilcher, Thomas
AU - Vinocur, Jeffrey M.
AU - Cano, Óscar
AU - Kean, Adam
AU - Mondesert, Blandine
AU - Nürnberg, Jan Hendrik
AU - Schaller, Robert D.
AU - Sharma, Parikshit S.
AU - Nishimura, Takuro
AU - Tung, Roderick
N1 - Publisher Copyright:
© 2020
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Cardiac resynchronization therapy
KW - Congenitally corrected transposition of the great arteries
KW - His-bundle pacing
KW - Left bundle branch pacing
KW - Physiological pacing
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U2 - 10.1016/j.hrthm.2020.01.033
DO - 10.1016/j.hrthm.2020.01.033
M3 - Article
AN - SCOPUS:85083248773
VL - 17
SP - 991
EP - 997
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 6
ER -