Implantation of a permanent left bundle branch pacing lead in a child after tetralogy of fallot repair. A case study

Conduction system pacing, including His bundle and left bundle branch pacing, is an increasingly utilized strategy in adult patients with bradyarrhythmias and atrioventricular conduction disorders. This technique helps prevent the development of heart failure caused by electrical and mechanical dyssynchrony associated with chronic ventricular pacing. These outcomes support the feasibiliy of this technique in younger pediatric patients under comparable clinical conditions. A distinct category includes children who have undergone congenital heart defect correction and require permanent cardiac pacing. These patients are at higher risk of developing pacing-induced сardiomyopathy due to non-physiologic ventricular contraction, while options for prevention and management remain limited. Biventricular pacing is technically challenging in pediatric patients, and algorithms for minimizing ventricular pacing cannot be applied in the presence of complete atrioventricular block. We report a case of left bundle branch pacing in a child with a history of surgical repair of tetralogy of Fallot and implantation of a permanent pacemaker for postoperative complete atrioventricular block.