Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site Academic Article uri icon

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abstract

  • 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.

authors

  • Janoušek, Jan
  • van Geldorp, Irene E
  • Krupičková, Sylvia
  • Rosenthal, Eric
  • Nugent, Kelly
  • Tomaske, Maren
  • Früh, Andreas
  • Elders, Jan
  • Hiippala, Anita
  • Kerst, Gunter
  • Gebauer, Roman A
  • Kubuš, Peter
  • Frias, Patrick
  • Gabbarini, Fulvio
  • Clur, Sally-Ann
  • Nagel, Bert
  • Ganame, Javier
  • Papagiannis, John
  • Marek, Jan
  • Tisma-Dupanovic, Svjetlana
  • Tsao, Sabrina
  • Nürnberg, Jan-Hendrik
  • Wren, Christopher
  • Friedberg, Mark
  • de Guillebon, Maxime
  • Volaufova, Julia
  • Prinzen, Frits W
  • Delhaas, Tammo

publication date

  • February 5, 2013

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