Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study

Janousek, J.; van Geldorp, I. E.; Krupickova, S.; Rosenthal, E.; Nugent, K.; Tomaske, M.; Fruh, A.; Elders, J.; Hiippala, A.; Kerst, G.; Gebauer, R. A.; Kubus, P.; Frias, P.; Gabbarini, F.; Clur, S. A.; Nagel, B.; Ganame, J.; Papagiannis, J.; Marek, J.; Tisma-Dupanovic, S.; Tsao, S.; Nurnberg, J. H.; Wren, C.; Friedberg, M.; de Guillebon, M.; Volaufova, J.; Prinzen, F. W.; Delhaas, T.

Circulation. 2013 Jan 1; 127(5):613-23

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.

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