Three-dimensional mapping for His-bundle pacing in pediatric patients, a case series

Introduction: Pediatric patients who receive pacemakers may have a lifetime of repeat exposure to fluoroscopy. His bundle pacing may provide better long-term pacing for these patients. To minimize fluoroscopy and for improved localization of the His bundle, we utilized three-dimensional mapping to guide His bundle pacing and we follow-up short-term results. Methods: An Octapolar Livewire catheter (Abbott, Minneapolis, USA) was used for mapping and location of the His bundle while 3-dimensional mapping via the EnSite Precision system (Abbott Medical, Abbott Park, IL) was utilized to create a 3-dimensional geometry. The EnSite Precision system also mapped and recorded His bundle signal strengths and earliest ventricular activation or retrograde His bundle activation. Results: Three patients are presented and followed for 4–5 months. The ages ranged from 10 to 15 years with 1 male patient. Diagnoses including progressive atrioventricular block, alternating bundle branch block and atrioventricular canal defect with complete heart block. All patients received selective His-bundle pacing systems. The range in fluoroscopy time was 6.4 to 9.9 min with 5.64 mGy to 10.18 mGy. Stable lead thresholds, impedances and sensing were present at last follow-up. Conclusions: His bundle pacing in our 3 pediatric patients including one with altered His-bundle physiology (case 3 with atrioventricular canal defect) was successful with good short-term follow-up results.