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Scott M, Needleman JS, Kean AC. Conduction System Pacing in Pediatrics and Congenital Heart Disease: A Case Report and Literature Review. J Innov Card Rhythm Manag 2024; 15:5749-5755. [PMID: 38444449 PMCID: PMC10911636 DOI: 10.19102/icrm.2024.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/28/2023] [Indexed: 03/07/2024] Open
Abstract
Conduction system pacing involving either His bundle pacing (HBP) or left bundle branch pacing (LBBP) is a modality that has been introduced as a safe and effective alternative to right ventricular (RV) pacing to help prevent pacemaker-associated cardiomyopathy. While HBP has been employed in the pediatric and congenital populations, several small studies have shown LBBP to be safe and effective in the pediatric population. We present a patient with congenital atrioventricular block and postoperative ventricular septal defect repair cardiomyopathy with subsequent left ventricular function improvement following a transition from an RV epicardial pacemaker system to an LBBP system. This case report serves as a foundation for a review of the current state of LBBP in pediatrics and congenital heart disease.
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Affiliation(s)
- Michael Scott
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph S. Needleman
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University, School of Medicine, Atlanta, GA, USA
| | - Adam C. Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Navarre BM, Clouthier KL, Ji X, Taylor A, Weldy CS, Dubin AM, Reddy S. miR Profile of Chronic Right Ventricular Pacing: a Pilot Study in Children with Congenital Complete Atrioventricular Block. J Cardiovasc Transl Res 2023; 16:287-299. [PMID: 36121621 PMCID: PMC10151311 DOI: 10.1007/s12265-022-10318-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022]
Abstract
Chronic ventricular pacing can lead to pacing-induced cardiomyopathy (PICM). Clinical data alone is insufficient to predict who will develop PICM. Our study aimed to evaluate the circulating miR profile associated with chronic right ventricular pacing in children with congenital complete AV block (CCAVB) and to identify candidate miRs for longitudinal monitoring. Clinical data and blood were collected from chronically paced children (N = 9) and compared with non-paced controls (N = 13). miR microarrays from the buffy coat revealed 488 differentially regulated miRs between groups. Pathway analysis predicted both adaptive and maladaptive miR signaling associated with chronic pacing despite preserved ventricular function. Greater profibrotic signaling (miRs-92a, 130, 27, 29) and sodium and calcium channel dysregulation (let-7) were seen in those paced > 10 years with the most dyregulation seen in a patient with sudden death vs. those paced < 10 years. These miRs may help to identify early adverse remodeling in this population.
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Affiliation(s)
- Brittany M Navarre
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Stanford, CA, 94304, USA
| | - Katie L Clouthier
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Stanford, CA, 94304, USA
| | - Xuhuai Ji
- Human Immune Monitoring Center and Functional Genomics Facility, Stanford University, Stanford, CA, 94305, USA
| | - Anne Taylor
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Stanford, CA, 94304, USA
| | - Chad S Weldy
- Department of Medicine (Cardiovascular), Stanford Medical Center, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Anne M Dubin
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Stanford, CA, 94304, USA
| | - Sushma Reddy
- Department of Pediatrics (Cardiology), Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Stanford, CA, 94304, USA.
- Cardiovascular Institute, Stanford University, Stanford, USA.
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To go left or right? Driving towards the best direction in paediatric pacing. Cardiol Young 2022; 33:760-765. [PMID: 35673795 DOI: 10.1017/s1047951122001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Permanent pacing in children with isolated congenital complete atrioventricular block may cause left ventricular dysfunction. To prevent it, alternative pacing sites have been proposed: left ventricular epicardial or selective right ventricular endocardial pacing. AIMS To compare the functional outcome (left ventricular systolic function and synchrony) in paediatric patients with congenital complete atrioventricular block and left ventricular apical epicardial or right ventricular transvenous mid-septal pacing. METHODS Retrospective study. Epicardial leads were implanted by standard surgical technique, transvenous leads by 3D electroanatomic mapping systems. 3D mapping acquired 3D right ventricular local pacing map and defined the narrowest paced QRS site. 3D mapping guided screw-in bipolar leads on that ventricular site. Electrocardiogram (ECG) (QRS duration) and echocardiographic data (synchrony: interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index; contractility: global longitudinal strain, ejection fraction) were recorded. Data are reported as median [interquartile ranges]. p < 0.05 was significant. RESULTS There were 19 transvenous systems (age 8.8 [6-14] years; right ventricular mid-septum) and 17 epicardial systems (0.04 [0.001-0.6] years; left ventricular apex). Post-implantation QRS significantly widened either in endocardial or in epicardial patients. Most patients reached 4-year follow-up. One-year and 4-year ejection fraction and global longitudinal strain were mostly within normal limits and did not show significant differences between the two groups and between the same endocardial/epicardial group. Synchrony parameters were within normal limits in the two groups. CONCLUSIONS Left ventricular apical epicardial pacing and 3D mapping-guided right ventricular mid-septal pacing preserved left ventricular contractility and synchrony in children and adolescents with congenital complete atrioventricular block at short-/mid-term follow-up, without relevant significant differences between the two groups.
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Wenlong D, Baojing G, Chencheng D, Jianzeng D. Preliminary study on left bundle branch area pacing in children:clinical observation of 12 cases. J Cardiovasc Electrophysiol 2022; 33:1558-1566. [PMID: 35508760 DOI: 10.1111/jce.15520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/21/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the safety and feasibility of left bundle branch area pacing (LBBAP) in children. METHODS This study observed 12 children attempted LBBAP from January 2019 to January 2021 in the department of pediatric cardiology of Anzhen Hospital prospectively.Clinical data, pacing parameters, electrocardiograms, intracardiac electrograms, echocardiographic measurements and complications were recorded at implant and during follow-up. RESULTS The 12 patients aged between 3 and 14 years old and weighted from 13 to 48kg. Eleven patients were diagnosed with third-degree atrioventricular block and 1 patient (case 4) suffered from cardiac dysfunction due to right ventricular apical pacing (RVAP). Left bundle branch area pacing was successfully achieved in all patients with narrow QRS complexes and V1 lead showed changes like right bundle branch block in the pacing electrocardiogram. Left ventricular ejection fraction in case 4 recovered on the 3rd day after LBBAP. The median of left ventricular end diastolic diameter Z score of the 12 patients decreased from 1.75 to1.05 3 months after implantation (p<0.05). The median of paced QRS duration was 103ms. The median of pacing threshold, R-wave amplitude and impedance were 0.85V, 15mV and 717Ω respectively and remained stable during follow-up. No complications such as loss of capture, lead dislodgement or septal perforation occurred. CONCLUSIONS Left bundle branch area pacing can be performed safely in children with narrow QRS duration and stable pacing parameters. Cardiac dysfunction caused by long-term RVAP can be corrected by LBBAP quickly. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dai Wenlong
- Department of Cardiology,Capital Medical University affiliated Beijing Anzhen Hospital, Beijing, 100029, China
| | - Guo Baojing
- Department of Pediatric Cardiology,Capital Medical University affiliated Beijing Anzhen Hospital, Beijing, 100029, China
| | - Dai Chencheng
- Department of Pediatric Cardiology,Capital Medical University affiliated Beijing Anzhen Hospital, Beijing, 100029, China
| | - Dong Jianzeng
- Department of Cardiology,Capital Medical University affiliated Beijing Anzhen Hospital, Beijing, 100029, China
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Reduction of fluoroscopy in conduction system pacing guided by electroanatomical mapping in pediatrics and congenital heart disease. Indian Pacing Electrophysiol J 2022; 22:182-185. [PMID: 35447346 PMCID: PMC9263654 DOI: 10.1016/j.ipej.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 10/29/2022] Open
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Deshpande S, Shenthar J, Khanra D, Isath A, Banavalikar B, Reddy S, Krishnappa D, Khan H, Kella D, Padmanabhan D. Outcomes in Congenital and Childhood Complete Atrioventricular Block: A Meta-analysis. J Cardiovasc Electrophysiol 2022; 33:493-501. [PMID: 35018695 DOI: 10.1111/jce.15358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/ CAVB) after pacemaker implantation are unclear. METHODS We performed a meta-analysis of all the studies of CCAVB. A systematic search of PubMed and CENTRAL databases from 1st January 1967 to 31st January 2020 was performed. The quality of studies included was critically appraised using the Newcastle-Ottawa scale, and outcome data were analyzed using the restricted maximum likelihood function. RESULTS Twenty-nine studies were eligible for analysis, with a total of 1553 patients. The all-cause-mortality was 5.7 % [95% CI: 2.5-9.9%], while PICM was seen in 3.8% [95% CI: 1.2-7.2]. Diagnosis at birth [effect size (ES)(95%CI): -2.23 (-0.36 to -0.10); p<0.001], presence of congenital heart disease ([ES(95%CI): -0.67 (0.41 to 0.93); p<0.001], younger age at pacemaker implantation ([ES(95%CI): -0.01 (-0.02 to -0.001); p=0.02], and duration of pacing [ES(95%CI): -0.03 (-0.05 to -0.003); p=0.03], were associated with an higher mortality on binominal logistic regression. None of the parameters were significant on multivariate analysis. CONCLUSION Pooled proportional mortality in patients with CCAVB and CAVB is 5.7% with an infrequent incidence of PICM (3.8%) in the paced patients with AVB suggesting that pacing in these patients is an effective management strategy with a low incidence of long-term side effects. Registry and randomized data can throw additional light regarding the natural history and appropriate management strategy in these patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Saurabh Deshpande
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Jayaprakash Shenthar
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Dibbendhu Khanra
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, United Kingdom
| | - Ameesh Isath
- Westchester Medical Centre, New York Medical College, New York, USA
| | - Bharatraj Banavalikar
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Satish Reddy
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Darshan Krishnappa
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Hassan Khan
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, USA
| | - Danesh Kella
- Piedmont Heart Institute, Rockdale, Atlanta, Georgia, USA
| | - Deepak Padmanabhan
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Ali AN, Wafa SS, Arafa HH, Samir R. Original Article--Outcomes of Pacing in Egyptian Pediatric Population. J Saudi Heart Assoc 2021; 33:61-70. [PMID: 33880330 PMCID: PMC8051327 DOI: 10.37616/2212-5043.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Permanent pacemakers are widely used in the pediatric population due to congenital and surgically acquired rhythm disturbances. The diversity and complexity of congenital heart diseases make device management a highly individualized procedure in pediatric pacing. We are also faced with special problems in pediatric age group as growth, children’s activity and infection susceptibility. This study aimed to present our institute’s experience in pediatric and adolescent pacemaker implantation and long-term outcomes. Methods This cross-sectional observational study included 100 pediatric patients who visited our outpatient clinics at Ain Shams University Hospitals for regular follow up of their previously implanted permanent pacemakers. All patients were subjected to history taking, clinical examination, ECG recording, echocardiography and elaborate device programming. Data about device types, device components’ longevity, subsequent procedures, complications were collected, with comparison between epicardial and endocardial pacemakers. Results Our study population ranged in age from 8 months to 18 years (mean 13.12 ± 5.04 years), 51 were males and 53 patients had congenital heart disease. Epicardial pacing represented 26% of our total population using only VVIR pacemakers, while endocardial pacing represented 74% of our population with 58.1% of them being VVIR pacemakers. First battery longevity was higher in endocardial batteries (108 months vs. 60 months, p value: 0.007). First lead longevity was also higher in endocardial leads (105 moths vs. 58 months, p value: 0.006). Complication rate was 25%; 8 patients had early complications (one insulation break in endocardial group). Late complications occurred in 17 patients (10 patients had lead fracture; 9 of them were endocardial, 2 insulation breaks in endocardial leads, 3 patients from epicardial group had lead failure of capture). In total, 16 patients had lead-related complications. There was no statistically significant difference between different lead models regarding lead-related complications. Conclusion Pacemakers in children are generally safe, but still having high rates of lead-related complications. Lead failure of capture was more common in epicardial leads. These complications had no relation to the model of the leads. Endocardial pacemakers showed higher first lead and first battery longevity compared to epicardial pacemakers.
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Affiliation(s)
- Ahmed Nabil Ali
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samir S Wafa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hosni Hosni Arafa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Samir
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Jimenez E, Zaban N, Sharma N, Narasimhan S, Martin-Chafee C, Lohr JL, Cortez D. His Bundle and Left Bundle Pacing in Pediatrics and Congenital Heart Disease: A Single Center Experience. Pediatr Cardiol 2020; 41:1425-1431. [PMID: 32567011 DOI: 10.1007/s00246-020-02398-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
Long-term right ventricular pacing is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatric patients and those with congenital heart disease (CHD). Research has shown that pacing-induced cardiomyopathy can be reversed with nonselective or selective His bundle pacing in adults, however, the information available about the use of this type of therapy in pediatrics and CHD is scarce. We performed a retrospective chart review of all the cases of His or left bundle pacing at the University of Minnesota, division of Pediatric Cardiology from January of 2019 to April of 2020. Parametric data are presented as mean ± standard deviation. Non-parametric data are presented as median value with interquartile ranges. Eight patients, ages 8 to 18 years (median of 11.5) and weight from 21.5 to 81.6 kg (median of 40 kg) underwent this procedure successfully. The most common structural heart disease was a repaired peri-membranous ventricular septal defect. Three patients (37.5%) had selective and three (37.5%) had nonselective His bundle pacing, and two patients (25%) had left bundle pacing. There were two cases of pacing-induced cardiomyopathy and each had a 14% and 16% improvement of the ejection fraction after nonselective His bundle pacing. There were no procedural complications. Selective and nonselective His bundle, as well as left bundle pacing may be a feasible procedure in pediatric patients with and without CHD. This procedure may improve pacing-induced cardiomyopathy in this population.
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Affiliation(s)
- Erick Jimenez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Nicholas Zaban
- Pediatric Cardiology, CentraCare Heart and Vascular Center, Saint Cloud, USA
| | - Nandita Sharma
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Shanti Narasimhan
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Chip Martin-Chafee
- Pediatric Cardiology, CentraCare Heart and Vascular Center, Saint Cloud, USA
| | - Jamie L Lohr
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA
| | - Daniel Cortez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, 5th Floor East Building, 2450 Riverside 2450, Minneapolis, MN, 55454, USA.
- Clinical Sciences, Lunds Universitet, Lund, Sweden.
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11
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Silvetti MS, Muzi G, Unolt M, D'Anna C, Saputo FA, Di Mambro C, Albanese S, Ammirati A, Ravà L, Drago F. Left ventricular (LV) pacing in newborns and infants: Echo assessment of LV systolic function and synchrony at 5‐year follow‐up. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:535-541. [DOI: 10.1111/pace.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Giulia Muzi
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Marta Unolt
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Carolina D'Anna
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Sonia Albanese
- Cardiac Surgery UnitBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Antonio Ammirati
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Lucilla Ravà
- Epidemiology UnitBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
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12
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El-Shabrawi M, Lotfy W, Hegazy R, Abdelaziz O, Sobhy R, Abdelmohsen G, Ibrahim H, Dohain AM. Evolution of ventricular function in children with permanent right ventricular pacing after tetralogy of Fallot repair: A midterm follow-up. J Card Surg 2020; 35:831-839. [PMID: 32092198 DOI: 10.1111/jocs.14477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aim to evaluate the midterm effect of chronic apical right ventricular (RV) pacing on right and left ventricular (LV) function using different modalities of echocardiography including conventional echocardiography, tissue Doppler imaging and two-dimension speckle tracking echocardiography. METHODS This case-control study enrolled 49 patients divided into two groups: a paced group and a nonpaced group. The paced group included 23 patients that underwent tetralogy of Fallot (TOF) repair and required permanent pacemaker insertion for postoperative complete heart block. The nonpaced group included 26 patients that had TOF repair at the same period. RESULTS The median age for the paced and nonpaced groups was 6 and 8 years, respectively (P = .169). The follow-up duration after TOF surgical repair was 4 years for the paced patients and 5 years for nonpaced patients (P = .411). In the nonpaced group, the QRS duration increased and LV global longitudinal strain (GLS) decreased significantly with increasing duration after TOF repair, P value was .006 and .042, respectively. In the paced group, tricuspid annular systolic plane excursion (TAPSE) was significantly correlated with age (r = .578; P = .004) and duration following TOF correction (r = .724; P < .001). CONCLUSION Chronic RV apical pacing in children after TOF repair was associated with better clinical status, preservation of RV systolic function, and prevention of progressive QRS prolongation. RV pacing was not associated with progressive deterioration of LV systolic function with increasing the time interval following TOF repair. Therefore, RV pacing can be beneficial in corrected TOF patients presenting with RV failure.
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Affiliation(s)
- Mortada El-Shabrawi
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Lotfy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ranya Hegazy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Abdelaziz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rodina Sobhy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gaser Abdelmohsen
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Ibrahim
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Dohain
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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13
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Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, Hsu DT, Lin KY, Price JF, Wilkinson JD, Colan SD. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e9-e68. [PMID: 31132865 DOI: 10.1161/cir.0000000000000682] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this scientific statement from the American Heart Association, experts in the field of cardiomyopathy (heart muscle disease) in children address 2 issues: the most current understanding of the causes of cardiomyopathy in children and the optimal approaches to diagnosis cardiomyopathy in children. Cardiomyopathies result in some of the worst pediatric cardiology outcomes; nearly 40% of children who present with symptomatic cardiomyopathy undergo a heart transplantation or die within the first 2 years after diagnosis. The percentage of children with cardiomyopathy who underwent a heart transplantation has not declined over the past 10 years, and cardiomyopathy remains the leading cause of transplantation for children >1 year of age. Studies from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry have shown that causes are established in very few children with cardiomyopathy, yet genetic causes are likely to be present in most. The incidence of pediatric cardiomyopathy is ≈1 per 100 000 children. This is comparable to the incidence of such childhood cancers as lymphoma, Wilms tumor, and neuroblastoma. However, the published research and scientific conferences focused on pediatric cardiomyopathy are sparcer than for those cancers. The aim of the statement is to focus on the diagnosis and classification of cardiomyopathy. We anticipate that this report will help shape the future research priorities in this set of diseases to achieve earlier diagnosis, improved clinical outcomes, and better quality of life for these children and their families.
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14
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Garcia RU, Safa R, Karpawich PP. Postoperative complete heart block among congenital heart disease patients: Contributing risk factors, therapies and long-term sequelae in the current era. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Baggio JM, Afiune CMC, Afiune JY, Sarabanda AV, Atik FA. Transvenous dual-chamber pacemaker after paediatric heart transplantation using left ventricle pacing through the coronary sinus. ESC Heart Fail 2018; 5:204-207. [PMID: 29356392 PMCID: PMC5793968 DOI: 10.1002/ehf2.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/28/2017] [Accepted: 11/27/2017] [Indexed: 11/11/2022] Open
Abstract
A 12‐year‐old child with end‐stage heart failure due to restrictive cardiomyopathy was submitted to orthotopic heart transplantation. Primary graft dysfunction required venous arterial extra‐corporeal membrane oxygenation. Heart function normalized, but complete atrioventricular block remained after 3 weeks. A dual‐chamber pacing with transvenous left ventricle pacing through the coronary sinus was performed. At 5‐year follow‐up, the patient is stable with the same pacing system and with preserved ventricular function.
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Affiliation(s)
- José Mario Baggio
- Division of Electrophysiology and Cardiac Device Unit, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | | | - Jorge Y Afiune
- Division of Pediatric Cardiology, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Alvaro V Sarabanda
- Division of Electrophysiology and Cardiac Device Unit, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Fernando A Atik
- Division of Cardiovascular Surgery and Transplant Unit, Instituto de Cardiologia do Distrito Federal, St Sudoeste Cruzeiro Novo, Brasília, 70658-700, Brazil
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16
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Pacing Induced Ventricular Dysfunction in a Child: Improvement with Reduction in Paced Rate. Pediatr Cardiol 2017; 38:1309-1310. [PMID: 28512720 DOI: 10.1007/s00246-017-1629-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Right ventricular (RV) pacing can be associated with impairment of left ventricular (LV) function due to electrical dyssynchrony and myocardial remodeling (Janousek et al. in J Cardiovasc Electrophysiol 15:470-474, 2004). RV-pacing induced ventricular dysfunction is reversible by techniques such as biventricular pacing and LV apical or LV free wall pacing or turning the pacemaker off which have all been shown to restore synchrony and improve left ventricular function (Janousek et al. in J Cardiovasc Electrophysiol 15:470-474, 2004; Geldorp et al. in Heart Fail Rev 16:305-314, 2011). We describe an infant with RV-pacing induced cardiomyopathy who improved when the pacing rate was reduced thus demonstrating the relationship between pacing rate and development of LV dysfunction.
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17
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Affiliation(s)
- Ian W. Hovis
- Address reprint requests and correspondence: Dr Ian W. Hovis, Division of Cardiology, Children's National Health System, 111 Michigan Ave, NW, Washington, DC 20010.Division of CardiologyChildren's National Health System111 Michigan AveNW, WashingtonDC20010
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Marshall AM. A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology. CONGENIT HEART DIS 2016; 11:462-467. [PMID: 27139742 DOI: 10.1111/chd.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
We perceived an increased incidence of surgical atrioventricular (AV) block in patients with single ventricle physiology undergoing two ventricle rehabilitation for hypoplastic left heart syndrome compared to the overall incidence of surgical AV block for our institution. Retrospective investigation of our center's data revealed a statistically significant increase in the incidence of surgical AV block in the single ventricle population and two ventricle rehabilitation population compared to the two ventricle population. Here we review the literature with respect to historic definitions, incidence, risk factors, pre- and post-op management, current indications for pacemaker placement and added cost and comorbidity associated with surgical AV block. We then offer possible strategies for decreasing the incidence of surgical AV block within both the single and two ventricle populations.
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Affiliation(s)
- Amanda M Marshall
- Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Neb, USA.
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19
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Horigome H. Dilated Cardiomyopathy in Children With Isolated Congenital Complete Atrioventricular Block. Circ J 2016; 80:1110-2. [PMID: 27053494 DOI: 10.1253/circj.cj-16-0284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Tsujii N, Miyazaki A, Sakaguchi H, Kagisaki K, Yamamoto T, Matsuoka M, Shima Y, Ichikawa H, Ohuchi H. High Incidence of Dilated Cardiomyopathy After Right Ventricular Inlet Pacing in Patients With Congenital Complete Atrioventricular Block. Circ J 2016; 80:1251-8. [DOI: 10.1253/circj.cj-15-1122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Nobuyuki Tsujii
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
- Department of Pediatrics, Nara Medical University
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koji Kagisaki
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tetsuya Yamamoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Michio Matsuoka
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yuriko Shima
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Hajime Ichikawa
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
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Silvetti MS, Di Carlo D, Ammirati A, Placidi S, Di Mambro C, Rava L, Drago F. Left ventricular pacing in neonates and infants with isolated congenital complete or advanced atrioventricular block: short- and medium-term outcome. Europace 2014; 17:603-10. [DOI: 10.1093/europace/euu180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 06/10/2014] [Indexed: 11/14/2022] Open
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Abstract
Efforts to use gene therapy to create a biological pacemaker as an adjunct or replacement of electronic pacemakers have been ongoing for about 15 years. For the past decade, most of these efforts have focused on the hyperpolarization-activated cyclic nucleotide gated-(HCN) gene family of channels alone or in combination with other genes. The HCN gene family is the molecular correlate of the cardiac pacemaker current, If. It is a suitable basis for a biological pacemaker because it generates a depolarizing inward current primarily during diastole and is directly regulated by cyclic adenosine monophosphate (cAMP), thereby incorporating autonomic responsiveness. However, biological pacemakers based either on native HCN channels or on mutated HCN channels designed to optimize biophysical characteristics have failed to attain the desired basal and maximal physiological heart rates in large animals. More recent work has explored dual gene therapy approaches, combining an HCN variant with another gene to reduce outward current, increase an additional inward current, or enhance cAMP synthesis. Several of these dual gene therapy approaches have demonstrated appropriate basal and maximal heart rates with little or no reliance on a backup electronic pacemaker during the period of study. Future research, besides examining the efficacy of other gene combinations, will need to consider the additional issues of safety and persistence of the viral vectors often used to deliver these genes to a specific cardiac region.
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Affiliation(s)
- Gerard J. J. Boink
- Heart Center, Department of Clinical & Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Netherlands Heart Institute, ICIN, Utrecht, the Netherlands
| | - Richard B. Robinson
- Department of Pharmacology, Center for Molecular Therapeutics, Columbia University, New York, NY, USA
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Matsuhisa H, Oshima Y, Maruo A, Hasegawa T, Tanaka A, Noda R, Iwaki R, Matsushima S, Tanaka T, Kido S. Pacing Therapy in Children. Circ J 2014; 78:2972-8. [DOI: 10.1253/circj.cj-14-0534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Ayako Maruo
- Department of Cardiovascular Surgery, Kobe Children’s Hospital
| | - Tomomi Hasegawa
- Department of Cardiovascular Surgery, Kobe Children’s Hospital
| | - Akiko Tanaka
- Department of Cardiovascular Surgery, Kobe Children’s Hospital
| | - Rei Noda
- Department of Cardiovascular Surgery, Kobe Children’s Hospital
| | - Ryuma Iwaki
- Department of Cardiovascular Surgery, Kobe Children’s Hospital
| | | | | | - Sachiko Kido
- Department of Cardiology, Kobe Children’s Hospital
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Ortega MC, Morejón AEG, Ricardo GS. Left ventricular synchrony and function in pediatric patients with definitive pacemakers. Arq Bras Cardiol 2013; 101:410-7. [PMID: 24061683 PMCID: PMC4081164 DOI: 10.5935/abc.20130189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/19/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern,producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. OBJECTIVE The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). METHODS LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. RESULTS LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). CONCLUSION Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function.
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Affiliation(s)
- Michel Cabrera Ortega
- Departamento de Arritmia e Estimulação Cardíaca - Cardiocentro
Pediátrico ¨William Soler¨, Havana, Cuba
- Mailing Address: Michel Cabrera Ortega, 100 y Perla, Altahabana, Boyeros
10800, Havana, Cuba. E-mail:
| | | | - Giselle Serrano Ricardo
- Havana, Cuba; Departamento de Ecocardiografia - Cardiocentro Pediátrico
¨William Soler¨, Havana, Cuba
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25
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Pathophysiology, clinical course, and management of congenital complete atrioventricular block. Heart Rhythm 2013; 10:760-6. [DOI: 10.1016/j.hrthm.2012.12.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Indexed: 10/27/2022]
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26
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van Geldorp IE, Vanagt WY, Vugts G, Willems R, Rega F, Gewillig M, Delhaas T. Late recovery of atrioventricular conduction after postsurgical chronic atrioventricular block is not exceptional. J Thorac Cardiovasc Surg 2013; 145:1028-1032. [DOI: 10.1016/j.jtcvs.2012.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/27/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Janoušek J, van Geldorp IE, Krupičková S, Rosenthal E, Nugent K, Tomaske M, Früh A, Elders J, Hiippala A, Kerst G, Gebauer RA, Kubuš P, Frias P, Gabbarini F, Clur SA, Nagel B, Ganame J, Papagiannis J, Marek J, Tisma-Dupanovic S, Tsao S, Nürnberg JH, Wren C, Friedberg M, de Guillebon M, Volaufova J, Prinzen FW, Delhaas T. Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study. Circulation 2012; 127:613-23. [PMID: 23275383 DOI: 10.1161/circulationaha.112.115428] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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Affiliation(s)
- Jan Janoušek
- Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic.
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The zebrafish as a novel animal model to study the molecular mechanisms of mechano-electrical feedback in the heart. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2012; 110:154-65. [PMID: 22835662 DOI: 10.1016/j.pbiomolbio.2012.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 02/07/2023]
Abstract
Altered mechanical loading of the heart leads to hypertrophy, decompensated heart failure and fatal arrhythmias. However, the molecular mechanisms that link mechanical and electrical dysfunction remain poorly understood. Growing evidence suggest that ventricular electrical remodeling (VER) is a process that can be induced by altered mechanical stress, creating persistent electrophysiological changes that predispose the heart to life-threatening arrhythmias. While VER is clearly a physiological property of the human heart, as evidenced by "T wave memory", it is also thought to occur in a variety of pathological states associated with altered ventricular activation such as bundle branch block, myocardial infarction, and cardiac pacing. Animal models that are currently being used for investigating stretch-induced VER have significant limitations. The zebrafish has recently emerged as an attractive animal model for studying cardiovascular disease and could overcome some of these limitations. Owing to its extensively sequenced genome, high conservation of gene function, and the comprehensive genetic resources that are available in this model, the zebrafish may provide new insights into the molecular mechanisms that drive detrimental electrical remodeling in response to stretch. Here, we have established a zebrafish model to study mechano-electrical feedback in the heart, which combines efficient genetic manipulation with high-precision stretch and high-resolution electrophysiology. In this model, only 90 min of ventricular stretch caused VER and recapitulated key features of VER found previously in the mammalian heart. Our data suggest that the zebrafish model is a powerful platform for investigating the molecular mechanisms underlying mechano-electrical feedback and VER in the heart.
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Salameh A, Dhein S, Blanke K, Rastan A, Hiyasat B, Dietze A, Sobiraij A, Dähnert I, Janousek J. Right or Left Ventricular Pacing in Young Minipigs With Chronic Atrioventricular Block. Circulation 2012; 125:2578-87. [DOI: 10.1161/circulationaha.111.079087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background—
Left ventricular (LV) dyssynchrony may occur as a result of right ventricular (RV) pacing and is a known risk factor for the development of heart failure. In children with complete atrioventricular block, pacing-induced dyssynchrony lasting for decades might be especially deleterious for LV function. To determine the hemodynamic and ultrastructural remodeling after either RV free wall or LV apical pacing, we used a chronic minipig model.
Methods and Results—
Fourteen piglets 8 weeks of age underwent atrioventricular node ablation and were paced from either the RV free wall or the LV apex at 120 bpm for 1 year (7 age-matched minipigs served as controls with spontaneous heart rates of 104±5 bpm). Echocardiographic examinations, pressure-volume loops, patch-clamp investigations, and examinations of connexin43, calcium-handling proteins, and histomorphology were carried out. RV free wall–paced minipigs exhibited significantly more LV dyssynchrony than LV apex–paced animals, which was accompanied by worsening of LV function (maximum LV mechanical delay/LV ejection fraction: RV free wall pacing, 154±36 ms/28±3%, LV apical pacing, 52±19 ms/45±2%, control 47±14 ms/62±1%;
P
=0.0001). At the cellular level, both pacemaker groups exhibited a significant reduction in L-type calcium and peak sodium current, shortening of action potential duration and amplitude, increased cell capacity, and alterations in the calcium-handling proteins that were similar for RV free wall– and LV apex–paced animals.
Conclusions—
The observed molecular remodeling seemed to be more dependent on heart rate than on dyssynchrony. LV apical pacing is associated with less dyssynchrony, a more physiological LV contraction pattern, and preserved LV function as opposed to RV free wall pacing.
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Affiliation(s)
- Aida Salameh
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Stefan Dhein
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Katja Blanke
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Ardawan Rastan
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Bahi Hiyasat
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Anna Dietze
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Axel Sobiraij
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Ingo Dähnert
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
| | - Jan Janousek
- From the Department of Paediatric Cardiology Heart Centre (A. Salameh, K.B., I.D.), Department of Cardiac Surgery, Heart Centre (S.D., A.R., B.H., A.D.), and Veterinary Faculty (A. Sobiraij), University of Leipzig, Leipzig, Germany, and Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Prague, Czech Republic (J.J.)
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HOROVITZ ALICE, DE GUILLEBON MAXIME, VAN GELDORP IRENEE, BORDACHAR PIERRE, ROUBERTIE FRANCOIS, IRIART XAVIER, DOUARD HERVÉ, HAISSAGUERRE MICHEL, THAMBO JEANBENOIT. Effects of Nonsystemic Ventricular Pacing in Patients with Transposition of the Great Arteries and Atrial Redirection. J Cardiovasc Electrophysiol 2012; 23:766-70. [DOI: 10.1111/j.1540-8167.2011.02271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.
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