Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
J Cardiovasc Electrophysiol. 2021 Oct;32(10):2692-2703. doi: 10.1111/jce.15213. Epub 2021 Aug 26.
Conduction system pacing (CSP) has emerged as an ideal physiologic pacing strategy for patients with permanent pacing indications. We sought to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with congenital heart disease (CHD).
Consecutive patients with CHD in which CSP was attempted were included. Safety and feasibility, implant tools and electrical parameters at implant and at follow-up were evaluated.
A total of 20 patients were included (10 with a previous device). A total of 10 patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. CSP was achieved in 75% of cases (10 His bundle pacing, 5 left bundle branch pacing) with left ventricular septal pacing in the remaining 5 patients. Procedure times and fluoroscopy times were prolongued (126 ± 82 min and 27 ± 30 min, respectively). Ventricular lead implant times widely varied ranging from 4 to 115 min, (mean 31 ± 28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 145 ± 36 ms at baseline to 116 ± 18 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.95 ± 0.65 V; R wave amplitude 9.2 ± 8.8 mV and pacing impedance 632 ± 183 Ohms, and remained stable at a median follow-up of 478 days (interquartile range: 225-567). Systemic ventricle systolic function and NYHA class (1.50 ± 0.51 vs. 1.10 ± 0.31; p = .008) significantly improved at follow-up. Lead revision was required in one patient at Day 4.
Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.
心脏传导系统起搏（CSP）已成为具有永久性起搏指征的患者的理想生理性起搏策略。我们旨在评估 CSP 在一系列未经选择的先天性心脏病（CHD）患者中的安全性和可行性。
纳入尝试进行 CSP 的 CHD 连续患者。评估安全性和可行性、植入工具以及植入时和随访时的电参数。
共纳入 20 例患者（其中 10 例有先前的设备）。共有 10 例患者为复杂 CHD 形式，9 例为中度缺损，1 例为单纯缺损。75%的病例（10 例希氏束起搏，5 例左束支起搏）实现了 CSP，其余 5 例患者行左心室间隔起搏。手术时间和透视时间延长（分别为 126±82 分钟和 27±30 分钟）。心室导线植入时间差异很大，范围为 4 至 115 分钟（平均 31±28 分钟），且频繁使用多个输送鞘（50%）。与 CSP 前相比，QRS 宽度从 145±36ms 减少至 116±18ms。植入的电参数包括：CSP 起搏阈值为 0.95±0.65V；R 波幅度为 9.2±8.8mV，起搏阻抗为 632±183 欧姆，在中位数随访 478 天（四分位距：225-567）时保持稳定。随访时系统性心室收缩功能和 NYHA 分级（1.50±0.51 比 1.10±0.31；p=0.008）显著改善。一名患者在第 4 天需要进行导线修订。
尽管植入技术复杂，但 CSP 在 CHD 患者中是安全且可行的。
