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Safety and feasibility of conduction system pacing in patients with congenital heart disease
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  • Oscar Cano,
  • Gopi Dandamudi,
  • Robert Schaller,
  • Víctor Pérez-Roselló,
  • Hebert Ayala,
  • Maite Izquierdo de Francisco,
  • Joaquín Osca,
  • Mª José Sancho-Tello,
  • Joaquín Rueda,
  • Eladio Ruiz,
  • Beatriz Insa,
  • Luis Martínez-Dolz,
  • Pugahendhi Vijayaraman
Oscar Cano
Hospital Universitario La Fe
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Gopi Dandamudi
CHI-Franciscan Health System
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Robert Schaller
University of Pennsylvania Health System
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Víctor Pérez-Roselló
Hospital Universitario La Fe
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Hebert Ayala
Hospital Universitario La Fe
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Maite Izquierdo de Francisco
Hospital Clinico Universitario
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Joaquín Osca
Hospital Politécnico y Universitario La Fe
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Mª José Sancho-Tello
Hospital Universitario y politécnico La Fe
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Joaquín Rueda
Hospital Universitari i Politecnic La Fe
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Eladio Ruiz
Hospital Politécnico y Universitario La Fe
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Beatriz Insa
Hospital Universitari i Politècnic La Fe
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Luis Martínez-Dolz
Hospital Universitari i Politècnic La FeLa Fe
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Pugahendhi Vijayaraman
Geisinger Heart Institute
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Abstract

Introduction: 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). Methods: 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. Results: A total of 20 patients were included (10 with a previous device). Ten patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) were achieved in all patients (10 HBP, 5 LBBP and 5 left ventricular septal pacing). Procedure times and fluoroscopy times were prolongued (126±82 min and 27±30 min, respectively). CSP lead implant times widely varied ranging from 4 to 115 minutes, (mean 31±28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 144±32 ms at baseline to 116±16 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.85±0.61V; R wave amplitude 9.8±9.2mV and pacing impedance 735±253 Ohms, and remained stable at a median follow-up of 478 days (IQR 225-567). Systemic ventricle systolic function and NYHA class (1.50±0.51 vs 1.10±0.31; p=0.008) significantly improved at follow-up. Lead revision was required in one patient at day-4. Conclusions: Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.
14 May 2021Submitted to Journal of Cardiovascular Electrophysiology
20 May 2021Submission Checks Completed
20 May 2021Assigned to Editor
24 May 2021Reviewer(s) Assigned
15 Jun 2021Review(s) Completed, Editorial Evaluation Pending
18 Jun 2021Editorial Decision: Revise Minor
02 Jul 20211st Revision Received
07 Jul 2021Assigned to Editor
07 Jul 2021Submission Checks Completed
07 Jul 2021Reviewer(s) Assigned
27 Jul 2021Review(s) Completed, Editorial Evaluation Pending
30 Jul 2021Editorial Decision: Revise Minor
30 Jul 20212nd Revision Received
03 Aug 2021Submission Checks Completed
03 Aug 2021Assigned to Editor
03 Aug 2021Reviewer(s) Assigned
06 Aug 2021Review(s) Completed, Editorial Evaluation Pending
09 Aug 2021Editorial Decision: Accept
Oct 2021Published in Journal of Cardiovascular Electrophysiology volume 32 issue 10 on pages 2692-2703. 10.1111/jce.15213