Comparison of His Bundle and Left Bundle Area Pacing in Pediatric and Adult Congenital Heart Disease Patients: A Single-Center Experience.

Conduction system pacing has been shown to offer advantages over traditional RV pacing for maintenance of ventricular function in adult patients requiring chronic ventricular pacing. Tools and implant techniques to target the His bundle (HBP) and left bundle area (LBAP) are designed for adult-size patients with structurally normal hearts. Data regarding procedural characteristics and pacing system performance in pediatric and young adult patients with congenital heart disease are limited. Review the implant characteristics and short-to-intermediate-term pacing parameters of pediatric and young adult patients undergoing conduction system pacing. A retrospective review of patients having undergone placement of a conduction system pacing lead was performed. Procedure times, fluoroscopy times, R-wave amplitudes, pacing thresholds, QRS duration, and left ventricular activation times were compared based on lead target site (HBP vs LBAP). Mann-Whitney U sample analysis was utilized to compare groups. Pacing thresholds were compared utilizing the Generalized Estimating Equation. 32 conduction pacing systems were placed in 31 patients between April 2018 and September 2024. The HBP group consisted of 11 patients and the LBAP group consisted of 20 patients. There were no significant demographic differences between the 2 cohorts. The LBAP group was found to have significantly lower chronic pacing thresholds (p < 0.05). Conduction system pacing is a viable option for pediatric patients in need of chronic ventricular pacing. Both HBP and LBAP is achievable with comparable procedure and fluoroscopy times and acute pacing thresholds, although chronic sensing parameters and pacing thresholds are more favorable for LBAP implants.