Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
23275383
DOI
10.1161/circulationaha.112.115428
PII: CIRCULATIONAHA.112.115428
Knihovny.cz E-resources
- MeSH
- Atrioventricular Block pathology physiopathology therapy MeSH
- Child MeSH
- Ventricular Dysfunction, Left diagnostic imaging physiopathology MeSH
- Electrocardiography MeSH
- Cardiac Pacing, Artificial methods MeSH
- Pacemaker, Artificial * MeSH
- Humans MeSH
- Adolescent MeSH
- Models, Cardiovascular MeSH
- Cross-Sectional Studies MeSH
- Radiography, Thoracic MeSH
- Retrospective Studies MeSH
- Heart Ventricles diagnostic imaging pathology physiopathology MeSH
- Stroke Volume physiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
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.
Circulation. 2013 Apr 16;127(15):e550 PubMed
References provided by Crossref.org
Cardiac resynchronization therapy in congenital heart disease
Device therapy in children with and without congenital heart disease
