| Permanent Cardiac Pacing in Children - Choosing the Optimal Pacing Site: A Multi-Center Study. | |
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MedLine Citation:
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PMID: 23275383 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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: 178 children (age <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were cross-sectionally studied. Median age at evaluation was 11·2 (inter-quartile range (IQR) 6·3-15·0) years. Median pacing duration was 5·4 (IQR 3·1-8·8) years. Pacing-sites were the free wall of the right ventricular (RV) outflow tract (RVOT, N=8), lateral RV (RVLat, N=44), RV apex (RVA, N=61), RV septum (RVS, N=29), LV apex (LVA, N=12), LV mid-lateral wall (LVLat, N=17), and LV base (LVB, N=7). LV synchrony, pump function and contraction efficiency were significantly affected by pacing-site and were superior in children paced at LVA/LVLat. LV dyssynchrony correlated inversely with LV ejection fraction (EF) (R=0·80, P=0·031). Pacing from RVOT/RVLat predicted significantly decreased LV function (LV EF <45 %; OR 10·72, CI 2·07-55·60, P= 0·005) whereas LVA/LVLat pacing was associated with preserved LV function (LV EF ≥55 %; OR 8·26, CI 1·46-47·62, P= 0·018). Presence of maternal auto-antibodies, gender, age at implantation, duration of pacing, DDD mode and QRS duration had no significant impact on LV EF. CONCLUSIONS: The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency and pump function in children that require life-long pacing. Of the sites studied, LVA/LVLat pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function. |
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Authors:
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Jan Janousek; Irene E van Geldorp; Sylvia Krupicková; Eric Rosenthal; Kelly Nugent; Maren Tomaske; Andreas Früh; Jan Elders; Anita Hiippala; Gunter Kerst; Roman A Gebauer; Peter Kubus; Patrick Frias; Fulvio Gabbarini; Sally-Ann Clur; Bert Nagel; Javier Ganame; John Papagiannis; Jan Marek; Svjetlana Tisma-Dupanovic; Sabrina Tsao; Jan-Hendrik Nürnberg; Christopher Wren; Mark Friedberg; Maxime de Guillebon; Julia Volaufova; Frits W Prinzen; Tammo Delhaas |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-30 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 University Hospital Motol, Prague, Czech Republic; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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