His Bundle pacing for congenital complete AV block: an attempt to fix a
broken heart ?
Introduction. The treatment of congenital complete AV block (CCAVB) is
burdened by RV-associated ventricular dysfunction at long-term in a
subgroup of patients. Methods and Results. Two CCAVB adolescents with
mild systolic dysfunction associated to VVIR pacing reached elective
pacemaker replacement after 10±1 years. They were upgraded to
physiologic stimulation by restoring AV synchrony and ventricular
activation via His bundle pacing (HBP). At 9-months follow-up both had
reverse left ventricular (LV) remodeling: LV end-diastolic volume index
decreased from 89±4 to 70±7 ml/m2, LV end-systolic volume index
decreased from 49±1 to 32 ml/m2, LVEF increased from 43±1% to 53±4%.
Conclusions. HBP can improve LV function in CCAVB adolescents. It should
be considered in the setting of LV dysfunction associated to RV pacing,
and should be explored as first-choice treatment from late childhood