Document Detail

Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study.
MedLine Citation:
PMID:  23275383     Owner:  NLM     Status:  MEDLINE    
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.
Jan Janoušek; Irene E van Geldorp; Sylvia Krupičková; Eric Rosenthal; Kelly Nugent; Maren Tomaske; Andreas Früh; Jan Elders; Anita Hiippala; Gunter Kerst; Roman A Gebauer; Peter Kubuš; 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:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2012-12-30
Journal Detail:
Title:  Circulation     Volume:  127     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-06-20     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  613-23     Citation Subset:  AIM; IM    
Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic.
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MeSH Terms
Atrioventricular Block / pathology*,  physiopathology,  therapy*
Cardiac Pacing, Artificial / methods*
Cross-Sectional Studies
Heart Ventricles / pathology*,  physiopathology,  radiography
Models, Cardiovascular
Pacemaker, Artificial*
Radiography, Thoracic
Retrospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology,  radiography
Erratum In:
Circulation. 2013 Apr 16;127(15):e550

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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