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Impact and Modifiers of Ventricular Pacing in Patients With Single Ventricle Circulation
H. Chubb, A. Bulic, D. Mah, JP. Moore, J. Janousek, J. Fumanelli, SY. Asaki, A. Pflaumer, AC. Hill, C. Escudero, SY. Kwok, J. Mangat, LA. Ochoa Nunez, S. Balaji, E. Rosenthal, W. Regan, M. Horndasch, H. Asakai, R. Tanel, RJ. Czosek, ML. Young,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 1983 do Před 1 rokem
Open Access Digital Library
od 1998-01-01
- MeSH
- dítě MeSH
- jednokomorové srdce * MeSH
- kohortové studie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- srdeční komory MeSH
- transplantace srdce * MeSH
- vrozené srdeční vady * MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Palliation of the single ventricle (SV) circulation is associated with a burden of lifelong complications. Previous studies have identified that the need for a permanent ventricular pacing system (PPMv) may be associated with additional adverse long-term outcomes. OBJECTIVES: The goal of this study was to quantify the attributable risk of PPMv in patients with SV, and to identify modifiable risk factors. METHODS: This international study was sponsored by the Pediatric and Congenital Electrophysiology Society. Centers contributed baseline and longitudinal data for functionally SV patients with PPMv. Enrollment was at implantation. Controls were matched 1:1 to PPMv subjects by ventricular morphology and sex, identified within center, and enrolled at matched age. Primary outcome was transplantation or death. RESULTS: In total, 236 PPMv subjects and 213 matched controls were identified (22 centers, 9 countries). Median age at enrollment was 5.3 years (quartiles: 1.5-13.2 years), follow-up 6.9 years (3.4-11.6 years). Median percent ventricular pacing (Vp) was 90.8% (25th-75th percentile: 4.3%-100%) in the PPMv cohort. Across 213 matched pairs, multivariable HR for death/transplant associated with PPMv was 3.8 (95% CI 1.9-7.6; P < 0.001). Within the PPMv population, higher Vp (HR: 1.009 per %; P = 0.009), higher QRS z-score (HR: 1.19; P = 0.009) and nonapical lead position (HR: 2.17; P = 0.042) were all associated with death/transplantation. CONCLUSIONS: PPMv in patients with SV is associated with increased risk of heart transplantation and death, despite controlling for increased associated morbidity of the PPMv cohort. Increased Vp, higher QRS z-score, and nonapical ventricular lead position are all associated with higher risk of adverse outcome and may be modifiable risk factors.
Children's Mercy Hospital University of Missouri Kansas City Missouri USA
Department of Cardiology Boston Children's Hospital Boston Massachusetts USA
Department of Paediatrics University of Tokyo Hospital Tokyo Japan
Department of Pediatric Cardiology Georg August University Medical Center Göttingen Germany
Department of Pediatrics Harvard Medical School Boston Massachusetts USA
Division of Cardiology Children's Hospital Los Angeles Los Angeles California USA
Division of Cardiology Department of Pediatrics UCLA Health System Los Angeles California USA
Joe DiMaggio Children's Hospital Hollywood Florida USA
Keck School of Medicine University of Southern California Los Angeles California USA
Paediatric Cardiology Evelina London Children's Hospital London United Kingdom
Paediatric Cardiology Great Ormond Street London United Kingdom
Pediatric Cardiology Unit Department of Women's and Child's Health University of Padova Padova Italy
Primary Children's Hospital University of Utah Salt Lake City Utah USA
Sibley Heart Center Atlanta Georgia USA
The Heart Institute Cincinnati Children's Hospital Medical Center Ohio USA
The Royal Children's Hospital MCRI and University of Melbourne Melbourne Victoria Australia
UCLA Cardiac Arrhythmia Center UCLA Health System Los Angeles California USA
University of Iowa Healthcare Iowa City Iowa USA
University of Michigan CS Mott Children's Hospital Ann Arbor Michigan USA
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- $a Chubb, Henry $u Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA. Electronic address: mhchubb@stanford.edu
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- $a BACKGROUND: Palliation of the single ventricle (SV) circulation is associated with a burden of lifelong complications. Previous studies have identified that the need for a permanent ventricular pacing system (PPMv) may be associated with additional adverse long-term outcomes. OBJECTIVES: The goal of this study was to quantify the attributable risk of PPMv in patients with SV, and to identify modifiable risk factors. METHODS: This international study was sponsored by the Pediatric and Congenital Electrophysiology Society. Centers contributed baseline and longitudinal data for functionally SV patients with PPMv. Enrollment was at implantation. Controls were matched 1:1 to PPMv subjects by ventricular morphology and sex, identified within center, and enrolled at matched age. Primary outcome was transplantation or death. RESULTS: In total, 236 PPMv subjects and 213 matched controls were identified (22 centers, 9 countries). Median age at enrollment was 5.3 years (quartiles: 1.5-13.2 years), follow-up 6.9 years (3.4-11.6 years). Median percent ventricular pacing (Vp) was 90.8% (25th-75th percentile: 4.3%-100%) in the PPMv cohort. Across 213 matched pairs, multivariable HR for death/transplant associated with PPMv was 3.8 (95% CI 1.9-7.6; P < 0.001). Within the PPMv population, higher Vp (HR: 1.009 per %; P = 0.009), higher QRS z-score (HR: 1.19; P = 0.009) and nonapical lead position (HR: 2.17; P = 0.042) were all associated with death/transplantation. CONCLUSIONS: PPMv in patients with SV is associated with increased risk of heart transplantation and death, despite controlling for increased associated morbidity of the PPMv cohort. Increased Vp, higher QRS z-score, and nonapical ventricular lead position are all associated with higher risk of adverse outcome and may be modifiable risk factors.
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