Permanent Cardiac Pacing in Children - Choosing the Optimal Pacing Site: A Multi-Center Study
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.
- Received April 30, 2012.
- Accepted December 18, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited