First Pediatric Application of Bachmann's Bundle Pacing and Left Bundle Branch Area Pacing for Bi‐Physiologic Conduction System Pacing

BACKGROUND: Atrial pacing at right atrial appendage causes nonphysiologic delays. Bachmann's bundle (BB) pacing preserves synchrony but lacks pediatric data. CASE SUMMARY: We report the first pediatric combined BB and left bundle branch area pacing in a 9-year-old boy (23.5 kg). With electrophysiologic and echocardiographic guidance, successful BB capture was achieved on a thin 2.1 mm atrial septum. Pacing significantly shortened P-wave duration (122-> 66 ms) and reduced interatrial mechanical delay (53-> 40 ms) on speckle-tracking echocardiography. CONCLUSION: This case demonstrates the acute success of BB pacing in a child. Bi-physiologic pacing is technically feasible and safe, though long-term outcomes warrant further evaluation.