Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site: A Multicenter Study

• Published in: Circulation (New York, N.Y.) Vol. 127; no. 5; pp. 613 - 623
• Main Authors: JANOUSEK, Jan, GELDORP, Irene E. Van, GEBAUER, Roman A, KUBUS, Peter, FRIAS, Patrick, GABBARINI, Fulvio, CLUR, Sally-Ann, NAGEL, Bert, GANAME, Javier, PAPAGIANNIS, John, MAREK, Jan, TISMA-DUPANOVIC, Svjetlana, KRUPICKOVA, Sylvia, TSAO, Sabrina, NURNBERG, Jan-Hendrik, WREN, Christopher, FRIEDBERG, Mark, DE GUILLEBON, Maxime, VOLAUFOVA, Julia, PRINZEN, Frits W, DELHAAS, Tammo, ROSENTHAL, Eric, NUGENT, Kelly, TOMASKE, Maren, FRÜH, Andreas, ELDERS, Jan, HIIPPALA, Anita, KERST, Gunter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 05.02.2013
• Subjects: Adolescent; Atrioventricular Block - pathology; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Cardiovascular system; Child; Cross-Sectional Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Models, Cardiovascular; Pacemaker, Artificial; Pharmacology. Drug treatments; Radiography, Thoracic; Retrospective Studies; Stroke Volume - physiology; Vasodilator agents. Cerebral vasodilators; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Human; Heart failure; pacemakers; Arrhythmia; Multicenter study; Cardiovascular disease; Conduction disorder; Excitability disorder; Bradycardia; pacing; Pacemaker; Heart disease; Heart block; pediatrics; Child
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.112.115428

We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. 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. 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.