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

Jeremy P. Moore, Roberto Gallotti, Kevin M. Shannon, Thomas Pilcher, Jeffrey M. Vinocur, Óscar Cano, Adam Kean, Blandine Mondesert, Jan Hendrik Nürnberg, Robert D. Schaller, Parikshit S. Sharma, Takuro Nishimura, Roderick Tung

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)991-997
Number of pages7
JournalHeart Rhythm
Volume17
Issue number6
DOIs
StatePublished - Jun 2020
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this