TY - JOUR
T1 - Permanent cardiac pacing in children
T2 - Choosing the optimal pacing site: A multicenter study
AU - Janoušek, Jan
AU - Van Geldorp, Irene E.
AU - Krupičková, Sylvia
AU - Rosenthal, Eric
AU - Nugent, Kelly
AU - Tomaske, Maren
AU - Früh, Andreas
AU - Elders, Jan
AU - Hiippala, Anita
AU - Kerst, Gunter
AU - Gebauer, Roman A.
AU - Kubuš, Peter
AU - Frias, Patrick
AU - Gabbarini, Fulvio
AU - Clur, Sally Ann
AU - Nagel, Bert
AU - Ganame, Javier
AU - Papagiannis, John
AU - Marek, Jan
AU - Tisma-Dupanovic, Svjetlana
AU - Tsao, Sabrina
AU - Nürnberg, Jan Hendrik
AU - Wren, Christopher
AU - Friedberg, Mark
AU - De Guillebon, Maxime
AU - Volaufova, Julia
AU - Prinzen, Frits W.
AU - Delhaas, Tammo
PY - 2013/2/5
Y1 - 2013/2/5
N2 - BACKGROUND-: We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. METHODS AND RESULTS-: One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction. CONCLUSIONS-: The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
AB - BACKGROUND-: We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. METHODS AND RESULTS-: One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction. CONCLUSIONS-: The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
KW - Heart block
KW - heart failure
KW - pacemakers
KW - pacing
KW - pediatrics
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U2 - 10.1161/CIRCULATIONAHA.112.115428
DO - 10.1161/CIRCULATIONAHA.112.115428
M3 - Article
C2 - 23275383
AN - SCOPUS:84873571540
SN - 0009-7322
VL - 127
SP - 613
EP - 623
JO - Circulation
JF - Circulation
IS - 5
ER -