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Paul T, Krause U, Sanatani S, Etheridge SP. Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years. Europace 2023; 25:euad155. [PMID: 37622573 PMCID: PMC10450816 DOI: 10.1093/europace/euad155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Abstract
This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients with congenital heart disease within the last 25 years. A special focus is directed to congenital atrioventricular (AV) block, the use of pacemakers, cardiac resynchronization therapy devices, and implantable cardioverter defibrillators in the young with and without congenital heart disease, Wolff-Parkinson-White syndrome, mapping and ablation technology, and understanding of cardiac genomics to untangle arrhythmic sudden death in the young.
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Affiliation(s)
- Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Shubhayan Sanatani
- Children’s Heart Centre, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Susan P Etheridge
- Pediatric Cardiology, University of Utah School of Medicine and Primary Children’s Medical Center, Salt Lake City, UT
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Ventricular Functional Analysis in Congenital Complete Heart Block Using Speckle Tracking: Left Ventricular Epicardial Compared to Right Ventricular Septal Pacing. Pediatr Cardiol 2023; 44:1160-1167. [PMID: 36625944 DOI: 10.1007/s00246-022-03093-7] [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: 11/07/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp). METHODS This was a single-center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as the control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle-tracking echocardiography (STE). RESULTS We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, Peak Longitudinal Strain myocardial (PLS Myo) [- 12.0 ± 3.3 vs. - 18.1 ± 1.9, p < 0.001] and Peak Longitudinal Strain endocardial (PLS endo) [- 16.1 ± 4.1 vs. 1.7 ± 1.7, p < 0.001]. STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstrated by lower values for PLS Myo (- 10.1 ± 3.2 vs. - 13.1 ± 2.9, p = 0.03) and PLS Endo (- 13.8 ± 4.4 vs. - 17.5 ± 3.3, p = 0.03). CONCLUSION STE was more sensitive in detecting subtle differences in LV function relative to standard conventional 2D echocardiography (SF and EF) in selected patients with CCAVB and a permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals.
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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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Küçük M, Balli S, Karadag H. Experience with implantation of Select Secure ® leads in paediatric patients. Acta Cardiol 2022:1-7. [PMID: 35315742 DOI: 10.1080/00015385.2022.2051878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: In this study, we aimed to investigate the safety, feasibility and efficacy of Select Secure® lead in a pure paediatric cohort and to present our experience with implantation technique, complications, and acute and midterm performance of the lead.Method: From 2014 to 2020, 42 consecutive paediatric patients underwent a cardiac device implantation with Select Secure® lead system. Patient demographics, implantation technique, and locations, sensing and pacing characteristics, impedances and any complications at implant and follow-up were investigated.Results: The mean age and weight of patients were 11.2 ± 3.5 years and 34.7 ± 14.8 kg, respectively. A total of 78 Select Secure® leads were successfully implanted. All ventricular leads were successfully anchored to the right ventricular midseptum. Implantation procedures were uneventful in all patients. We showed that atrial and ventricular sensing, pacing thresholds, and impedance measurements did not change significantly and that adequate pacing parameters were achieved in our patients during a median follow-up period of 47 months (4 - 68). Atrial and ventricular sensing, pacing thresholds and impedance measurements remained almost the same during the study period.Conclusions: In this study, we found that the Select Secure® transvenous pacing system was safe and feasible in paediatric patients without any major complications and with very stable electrical performance in the acute and midterm period.
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Affiliation(s)
- Mehmet Küçük
- Department of Paediatric Cardiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sevket Balli
- Department of Paediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin Karadag
- Department of Paediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Silvetti MS, Pazzano V, Battipaglia I, Saputo FA, Mizzon C, Gimigliano F, Ammirati A, Ravà L, Drago F. Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients. Heart Rhythm 2020; 18:434-442. [PMID: 33307214 DOI: 10.1016/j.hrthm.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction. OBJECTIVE The purpose of this study was to determine whether EAM-guided selective RV septal pacing preserves LV contractility/synchrony in pediatric patients with complete atrioventricular block (CAVB) and no other congenital heart defects. METHODS Prospective analysis of children/adolescents who underwent EAM-guided selective RV pacing was performed. A 3D pacing map guided ventricular lead implantation at septal sites with narrow paced QRS. Serial echocardiograms were obtained after pacemaker implantation to monitor for function (volumes, ejection fraction [EF], global longitudinal/circumferential strain) and synchrony (interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index). Data are reported as median (25th-75th percentile). RESULTS Thirty-two CAVB patients (age 9.8 [7.0-14.0] years; 11 with a previous pacing system) underwent selective RV septal pacing (13 DDD, 19 VVIR pacemaker; midseptum 22, parahisian 7, RV outflow tract 3) with narrow paced QRS (110 [100-120] ms) and low radiation exposure. Follow-up over 24 (5-33) months showed preserved LV function and synchrony, without significant differences between pacing sites (midseptum-parahisian) and mode (VVIR-DDD). EF decreased after implantation in patients without previous pacing, although values were mainly within normal limits. Three parahisian patients underwent early lead repositioning. CONCLUSION EAM-guided selective RV septal pacing is a feasible technique associated with preserved LV systolic function and synchrony and low radiation exposure in pediatric patients with CAVB.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart).
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Fabio Anselmo Saputo
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Chiara Mizzon
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Fabrizio Gimigliano
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Antonio Ammirati
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Lucilla Ravà
- Epidemiology Institute, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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Joyce J, O'Leary ET, Mah DY, Harrild DM, Rhodes J. Cardiac resynchronization therapy improves the ventricular function of patients with Fontan physiology. Am Heart J 2020; 230:82-92. [PMID: 33017579 DOI: 10.1016/j.ahj.2020.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022]
Abstract
Past studies have not detected consistent improvement in ventricular function (VFxn) following initiation of cardiac resynchronization therapy (CRT) in Fontan patients. However, these studies used qualitative assessments of VFxn and/or quantitative assessments of VFxn that rely upon anatomic and/or geometric assumptions that may not be valid in patients with single ventricles. To address this, we used quantitative indices of global VFxn (dP/dtic and the Tei index) that are not encumbered by the limitations associated with the indices used in previous studies of CRT in Fontan patients. METHODS Patients with Fontan physiology who had received CRT therapy from 2004 to 2019 were included in the study. They were compared to a concurrent group of Fontan patients who had received standard dual-chamber pacemakers (DCPMs). RESULTS VFxn was assessed at 3 time points: prior to, shortly after, and late after initiation of pacemaker therapy. Prior to initiation of pacemaker therapy, VFxn of the CRT patients tended to be worse than that of the DCPM patients. For both groups, VFxn appeared to be stable or slightly improved shortly after initiation of pacemaker therapy. In the CRT group, VFxn improved significantly between early and late follow-up. In contrast, VFxn in DCPM patients tended to decline during this period. Changes in VFxn correlated with concurrent changes in New York Heart Association classification. CONCLUSIONS Quantitative assessments of VFxn using indices not confounded by complex cardiac anatomy, segmental wall motions abnormalities, or inappropriate geometric assumptions revealed that CRT in Fontan patients is associated with preservation or improvement VFxn compared to standard DCPM. Changes in VFxn correlate with concurrent changes in New York Heart Association classification.
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Affiliation(s)
- Jeremiah Joyce
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA
| | - Jonathan Rhodes
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA.
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Kovanda J, Ložek M, Ono S, Kubuš P, Tomek V, Janoušek J. Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function. Europace 2020; 22:306-313. [PMID: 31808515 DOI: 10.1093/europace/euz325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/05/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Left ventricular apical pacing (LVAP) has been reported to preserve left ventricular (LV) function in chronically paced children with complete atrioventricular block (CAVB). We sought to evaluate long-term feasibility of LVAP and the effect on LV mechanics and exercise capacity as compared to normal controls. METHODS AND RESULTS Thirty-six consecutive paediatric patients with CAVB and LVAP in the absence (N = 22) or presence of repaired structural heart disease (N = 14, systemic LV in all) and 25 age-matched normal controls were cross-sectionally studied after a median of 3.9 (interquartile range 2.1-6.8) years of pacing using echocardiography and exercise stress testing. Pacemaker implantation was uneventful and there was no death. Probability of the absence of pacemaker-related surgical revision (elective generator replacement excluded) was 89.0% at 5 years after implantation. Left ventricular apical pacing patients had lower maximum oxygen uptake (P = 0.009), no septal to lateral but significant apical to basal LV mechanical delay (P < 0.001) which correlated with decreased LV contraction efficiency (P = 0.001). Left ventricular ejection fraction and global longitudinal LV strain were, however, not different from controls. Results were similar in both the presence and absence of structural heart disease. CONCLUSION Left ventricular apical pacing is technically feasible with a low reintervention rate. Mechanical synchrony between LV septum and free wall is maintained at the price of an apical to basal mechanical delay associated with LV contraction inefficiency as compared to healthy controls. Global LV systolic function is, however, not negatively affected by LVAP.
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Affiliation(s)
- Jan Kovanda
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Miroslav Ložek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic.,Department of Biomedical Informatics, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Shin Ono
- Department of Pediatric Cardiology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Viktor Tomek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jan Janoušek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
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Egbe AC, Najam M, Banala K, Vojjini R, Osman K, Abhishek D. Effect of right ventricular pacing on left ventricular systolic function in patients with Tetralogy of Fallot. IJC HEART & VASCULATURE 2020; 26:100426. [PMID: 31763440 PMCID: PMC6864126 DOI: 10.1016/j.ijcha.2019.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
Background Prevalence of pacemaker-induced cardiomyopathy (PICM) in adults with congenital heart disease is unknown. Tetralogy of Fallot (TOF) is a common diagnosis in the adult congenital heart disease population, and the purpose of this study was to determine association between frequent right ventricular (RV) pacing and temporal decrease in left ventricular ejection fraction (LVEF) from pre-implantation to 2-years post-implantation (LVEFpost-pre) in TOF patients. Methods We studied TOF patients that received RV leads only (N = 51) and a reference group of 7 patients with atrial pacing or biventricular pacing. We defined PICM as a ≥10% decrease in LVEF resulting in LVEF <50%. Linear regression was used to assess relationship between frequent RV pacing (≤20%, 21–40%, >40%) and LVEFpost-pre. Results PICM occurred in 2 (4%) of 51 patients in RV pacing group. LVEFpost-pre was +3% (95% confidence interval [CI] 0% to +5%) in the reference group and −4% (95% CI −11% to +2%) in RV pacing group. No significant difference occured in LVEFpost-pre between the reference group (LVEFpost-pre +3%) vs RV pacing ≤20% (LVEFpost-pre +1%) vs RV pacing 21–40% (LVEFpost-pre −3%) vs RV pacing >40% (LVEFpost-pre −5%), p = 0.318. There was also no association between frequent RV pacing and LVEFpost-pre, R2 = 0.307, p = 0.10. Conclusion PICM occurred in 4% of TOF patients receiving RV pacing, and there was no association between frequent RV pacing and temporal decline in LVEF. Further studies are required to determine the long-term impact of RV pacing in the TOF population, and explore optimal treatment strategies.
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Leoni L, Padalino M, Biffanti R, Ferretto S, Vettor G, Corrado D, Stellin G, Milanesi O, Iliceto S. Pacemaker remote monitoring in the pediatric population: is it a real solution? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:565-71. [PMID: 25645302 DOI: 10.1111/pace.12600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 01/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical utility of remote monitoring of implantable cardiac devices has been previously demonstrated in several trials in the adult population. The aim of this study was to assess the clinical utility of remote monitoring in a pediatric population undergoing pacemakers implantation. METHODS The study population included 73 consecutive pediatric patients who received an implantable pacemaker. The remote device check was programmed for every 3 months and all patients had a yearly out-patient visit. Data on device-related events, hospitalization, and other clinical information were collected during remote checks and out-patient visits. RESULTS During a mean follow-up of 18 ± 10 months, 470 remote transmissions were collected and analyzed. Two deaths were reported. Eight transmissions (1.7%) triggered an urgent out-patient visit. Twenty percent of transmissions reported evidence of significant clinical or technical events. All young patients and their families were very satisfied when using remote monitoring to replace out-patient visits. CONCLUSIONS The ease in use, together with satisfaction and acceptance of remote monitoring in pediatric patients, brought very good results. The remote management of our pediatric population was safe and remote monitoring adequately replaced the periodic out-patient device checks without compromising patient safety.
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Affiliation(s)
- Loira Leoni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Ventricular dyssynchrony and function improve following catheter ablation of nonseptal accessory pathways in children. BIOMED RESEARCH INTERNATIONAL 2013; 2013:158621. [PMID: 23853767 PMCID: PMC3703375 DOI: 10.1155/2013/158621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/09/2013] [Indexed: 11/24/2022]
Abstract
Introduction. Paradoxical or hypokinetic interventricular septal motion has been described in patients with septal or paraseptal accessory pathways. Data regarding nonseptal pathways is limited. Methods and Results. We quantified left ventricular dyssynchrony and function in 16 consecutive children, 14.2 ± 3.7 years, weighing 53 ± 17 kg, prior to and following catheter ablation of bidirectional septal (N = 6) and nonseptal (N = 10) accessory pathways. Following ablation, the left ventricular ejection fraction increased by 4.9 ± 2.1% (P = 0.038) from a baseline value of 57.0% ± 7.8%. By tissue Doppler imaging, the interval between QRS onset and peak systolic velocity (Ts) decreased from a median of 33.0 ms to 18.0 ms (P = 0.013). The left ventricular ejection fraction increased to a greater extent following catheter ablation of nonseptal (5.9% ± 2.6%, P = 0.023) versus septal (2.5% ± 4.1%, P = 0.461) pathways. The four patients with an ejection fraction <50%, two of whom had left lateral pathways, improved to >50% after ablation. Similarly, the improvement in dyssynchrony was more marked in patients with nonseptal versus septal pathways (difference between septal and lateral wall motion delay before and after ablation 20.6 ± 7.1 ms (P = 0.015) versus 1.4 ± 11.4 ms (P = 0.655)). Conclusion. Left ventricular systolic function and dyssynchrony improve after ablation of antegrade-conducting accessory pathways in children, with more pronounced changes noted for nonseptal pathways.
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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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Lotfy W, Hegazy R, AbdElAziz O, Sobhy R, Hasanein H, Shaltout F. Permanent cardiac pacing in pediatric patients. Pediatr Cardiol 2013; 34:273-80. [PMID: 22886361 DOI: 10.1007/s00246-012-0433-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow-up assessment is needed for further evaluation.
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Affiliation(s)
- Wael Lotfy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs 2012; 16:23-33. [PMID: 23104398 DOI: 10.1007/s10047-012-0668-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
The number of pediatric pacemakers implanted is still relatively small. Children requiring pacing therapy have characteristics that are distinct from those of adults, including physical size, somatic growth, and cardiac anomalies. Considering these features, long-term follow-up of pediatric pacemaker implantation is necessary. Selection of appropriate generators, pacing modes, pacing sites, and leads is important. Generally, epicardial leads are commonly used in small infants. On the other hand, the use of endocardial leads in children is increasing worldwide because of their benefits over epicardial leads, such as minimal invasiveness, lower pacing threshold, and longer generator longevity. Endocardial leads are not suitable for patients with intracardiac shunts because of the high risk of systemic thrombosis. Venous occlusion is another significant problem with endocardial leads. With the increase in the number of pacing device implantations, the incidence of infection from such devices is also increasing. Complete device removal is sometimes recommended to treat device infection, but experience in the removal of endocardial leads in children is still scarce. This article gives an overview of pacing therapy in the pediatric population, including discussions on new pacing systems, such as remote monitoring systems, magnetic imaging compliant pacemaker systems, and leadless pacing devices.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Perry JC. Sudden cardiac death and malignant arrhythmias: the scope of the problem in adult congenital heart patients. Pediatr Cardiol 2012; 33:484-90. [PMID: 22318852 DOI: 10.1007/s00246-012-0171-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/19/2011] [Indexed: 01/20/2023]
Abstract
A key component of recognizing sudden cardiac death (SCD) risk in the adult congenital heart disease (ACHD) patient is the recognition of heart failure risk for each physiology. The risk of SCD is an accrued phenomenon, representing the influences of anatomy, genetics, surgical and catheter interventions, and long-term sequelae of residual hemodynamic issues. These all lead to a substrate for tachyarrhythmia. It is beneficial in thinking about all of the potential combinations of CHD anatomy and physiologies to categorize SCD risk for the ACHD patient in terms of systemic left-ventricular failure, systemic right-ventricular failure, subpulmonary ventricular failure, the dyssynchronous contractility states due to bundle branch block, and single-site ventricular pacing. This article reviews important issues in arrhythmogenesis for ACHD patients with all of these physiologies and discusses potential cardiac rhythm device-management needs.
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Affiliation(s)
- James C Perry
- Electrophysiology and Adult Congenital Heart Programs, UCSD/Rady Children's Hospital San Diego, San Diego, CA, USA.
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van Geldorp IE, Vanagt WY, Prinzen FW, Delhaas T. Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease. Heart Fail Rev 2011; 16:305-14. [PMID: 21107685 PMCID: PMC3074059 DOI: 10.1007/s10741-010-9207-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In children with congenital or acquired complete atrioventricular (AV) block, ventricular pacing is indicated to increase heart rate. Ventricular pacing is highly beneficial in these patients, but an important side effect is that it induces abnormal electrical activation patterns. Traditionally, ventricular pacemaker leads are positioned at the right ventricle (RV). The dyssynchronous pattern of ventricular activation due to RV pacing is associated with an acute and chronic impairment of left ventricular (LV) function, structural remodeling of the LV, and increased risk of heart failure. Since the degree of pacing-induced dyssynchrony varies between the different pacing sites, ‘optimal-site pacing’ should aim at the prevention of mechanical dyssynchrony. Especially in children, generally paced from a very early age and having a perspective of life-long pacing, the preservation of cardiac function during chronic ventricular pacing should take high priority. In the perspective of the (patho)physiology of ventricular pacing and the importance of the sequence of activation, this paper provides an overview of the current knowledge regarding possible alternative sites for chronic ventricular pacing. Furthermore, clinical implications and practical concerns of the various pacing sites are discussed. The review concludes with recommendations for optimal-site pacing in children.
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Affiliation(s)
- Irene E van Geldorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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TAKEMOTO MASAO, NAKASHIMA ATSUHIRO, MUNEUCHI JUN, YAMAMURA KENICHIRO, SHIOKAWA YUICHI, SUNAGAWA KENJI, TOMINAGA RYUJI. Para-Hisian Pacing for a Pediatric Patient with a Congenitally Corrected Transposition of the Great Arteries (SLL). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:e4-7. [DOI: 10.1111/j.1540-8159.2009.02559.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen CA, Wang JK, Lin MT, Lu CW, Wu KL, Chiu SN, Chiu HH, Wu ET, Lue HC, Wu MH. Dilated Cardiomyopathy After Long-Term Right Ventricular Apical Pacing in Children With Complete Atrioventricular Block: Role of Setting of Ventricular Pacing. J Card Fail 2009; 15:681-8. [DOI: 10.1016/j.cardfail.2009.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 03/26/2009] [Accepted: 04/10/2009] [Indexed: 11/28/2022]
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Pachón Mateos JC, Pachón Mateos EI, Pachón Mateos JC. Right ventricular apical pacing: the unwanted model of cardiac stimulation? Expert Rev Cardiovasc Ther 2009; 7:789-99. [PMID: 19589115 DOI: 10.1586/erc.09.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite having a huge benefit in enabling heart rate control, cardiac pacing by stimulating the right ventricular apex causes an artificial iatrogenic left bundle-branch block-like syndrome. As a result, QRS widening and cardiac wall desynchronization occurs. The problems caused by this undesirable pacemaker side effect have been ignored, as they are counteracted by the great benefit of cardiac rate correction. However, the compelling evidence about its harmful effect presented in this article cannot be disregarded and should start an attitude change toward alternate sites of ventricular pacing and preclusion of the right ventricular apex stimulation.
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Affiliation(s)
- José Carlos Pachón Mateos
- Sao Paulo Heart Hospital Electrophysiology and Arrhythmia Service, Pacemaker Service of the Sao Paulo Cardiology Institute, Pacemaker Brazilian Registry, Brazil
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Tomaske M, Breithardt OA, Bauersfeld U. Preserved cardiac synchrony and function with single-site left ventricular epicardial pacing during mid-term follow-up in paediatric patients. Europace 2009; 11:1168-76. [DOI: 10.1093/europace/eup178] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cantu F, De Filippo P, Gabbarini F, Borghi A, Brambilla R, Ferrero P, Comisso J, Marotta T, De Luca A, Gavazzi A. Selective-site pacing in paediatric patients: a new application of the Select Secure system. Europace 2009; 11:601-6. [DOI: 10.1093/europace/eup058] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chronic left ventricular pacing preserves left ventricular function in children. Pediatr Cardiol 2009; 30:125-32. [PMID: 18704551 DOI: 10.1007/s00246-008-9284-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/07/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2xLV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7%+/-6.0%) than in the LVP (32.2%+/-5.2%) or control (29.3%+/-4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8+/-0.2) than in the LVP (1.4+/-0.1) or control (1.4+/-0.2) children. The SPWMD was significantly larger in the RVP (338+/-20 ms) than in the LVP (-16+/-14 ms) or control (-5+/-35 ms) group, whereas QRS duration was similarly longer in the RVP (157+/-10 ms) and LVP (158+/-22 ms) groups compared than in the control group (69+/-7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.
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Marijon E, Villain E. Right Ventricular Pacing and Left Ventricular Dysfunction in Congenital Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:391. [DOI: 10.1111/j.1540-8159.2008.01005.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Villain E. Indications for Pacing in Patients with Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31 Suppl 1:S17-20. [DOI: 10.1111/j.1540-8159.2008.00948.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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VANAGT WARDY, PRINZEN FRITSW, DELHAAS TAMMO. Physiology of Cardiac Pacing in Children: The Importance of the Ventricular Pacing Site. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31 Suppl 1:S24-7. [DOI: 10.1111/j.1540-8159.2008.00950.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kurosaki KI, Miyazaki A, Watanabe K, Echigo S. Long-Term Outcome of Isolated Congenital Complete Atrioventricular Block Pacing Since Neonatal Period Experience at a Single Japanese Institution. Circ J 2008; 72:81-7. [DOI: 10.1253/circj.72.81] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Aya Miyazaki
- Department of Pediatrics, National Cardiovascular Center
| | - Ken Watanabe
- Department of Pediatrics, National Cardiovascular Center
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Vanagt WY, Prinzen FW, Delhaas T. Reversal of pacing-induced heart failure by left ventricular apical pacing. N Engl J Med 2007; 357:2637-8. [PMID: 18094389 DOI: 10.1056/nejmc072317] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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BEAUFORT-KROL GERTIEC, SCHASFOORT-VAN LEEUWEN MIEKJ, STIENSTRA YMKJE, BINK-BOELKENS MARGREETT. Longitudinal Echocardiographic Follow-Up in Children with Congenital Complete Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1339-43. [DOI: 10.1111/j.1540-8159.2007.00868.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berul CI, Villafane J, Atkins DL, Cecchin F, Kirsh JA, Johns JA, Kanter RJ, Karpawich PP. Pacemaker Lead Prolapse through the Pulmonary Valve in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1183-9. [PMID: 17897120 DOI: 10.1111/j.1540-8159.2007.00839.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transvenous pacemaker leads in children are often placed with redundant lead length to allow for anticipated patient growth. This excess lead may rarely prolapse into the pulmonary artery and potentially interfere with valve function. We sought to determine the response to lead repositioning on pulmonary valve insufficiency. METHODS Retrospective reviews of demographics, lead type, implant duration, and radiography and echocardiography. RESULTS A total of 11 pediatric patients were identified with lead prolapse through the pulmonary valve, of which nine patients underwent procedures to retract and reposition the lead (age at implant 9 +/- 4 years, age at revision 13 +/- 4 years). The implant duration prior to revision was 4 +/- 3 years. Two leads required radiofrequency extraction sheaths for removal, two pulled back using a snare, while five leads were simply retracted and repositioned. Tricuspid regurgitation was none/trivial (three), mild (four), or moderate (two) and only two improved with repositioning or replacement. Pulmonary regurgitation preoperatively was mild (three), mild-moderate (two), or moderate (four) compared with trivial (three), mild (four), and moderate (two) after revision. Patients with longer-term implanted leads had less improvement in pulmonary insufficiency. Two patients had mild pulmonary stenosis from lead-related obstruction. CONCLUSIONS Prolapse of transvenous pacing leads into the pulmonary artery can occur when excess slack is left for growth. Leads can often be repositioned, but may require extraction and replacement, particularly if chronically implanted and adherent to valve apparatus. Lead revision does not always resolve pulmonary insufficiency, potentially leaving permanent valve damage.
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Affiliation(s)
- Charles I Berul
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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30
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Ahlberg SE, Grenz NA, Ewert DL, Iaizzo PA, Mulligan LJ. Effect of pacing site on systolic mechanical restitution curves in the in vivo canine model. CARDIOVASCULAR ENGINEERING (DORDRECHT, NETHERLANDS) 2007; 7:89-96. [PMID: 17876706 DOI: 10.1007/s10558-007-9033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Pacing site is known to influence the contractile state of the ventricle. Non-physiologic pacing sites such as the right ventricular apex (RVA) or left ventricular freewall (LVFW) have been shown to decrease the contractile state of normal myocardium, due to abnormal electrical propagation. The impact of pacing at these sites may alter mechanical restitution (MR), a fundamental cardiac property involving the electro-mechanical regulation of contraction. This, in turn, may affect cardiac function. The present study was conducted to determine if pacing site alters the time constant of MR: tau. METHODS AND RESULTS Anesthetized canines (n = 6) were acutely paced at four sites: right atrium (RA), RVA, right ventricular septum (RVS), and LVFW. MR data was captured by the S1-S2 pacing protocol and used to create MR curves, generating a restitution time constant, tau, at each site. No significant difference in tau was found between pacing sites. A linear regression analysis of MR curves revealed that there was no significant difference in slope between pacing sites. CONCLUSION Although pacing site has been found to influence the contractile state of the ventricle, this is the first known study to demonstrate no change in tau in an in vivo preparation. This suggests that alteration of electro-mechanical coupling described by MR is not sufficiently robust to provide insight into pacing site and cardiac function in healthy hearts.
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Affiliation(s)
- Sarah E Ahlberg
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Tomaske M, Harpes P, Prêtre R, Dodge-Khatami A, Bauersfeld U. Evolution of paced QRS and QTc intervals in children with epicardial pacing leads. Clin Res Cardiol 2007; 96:787-93. [PMID: 17687506 DOI: 10.1007/s00392-007-0558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
AIMS Permanent ventricular pacing in children is associated with ventricular dysfunction due to asynchronous activation. It is unclear whether paced QRS intervals increase disproportionately over time, which could potentially cause ventricular dysfunction. METHODS A total of 52 children, with bipolar steroideluting epicardial leads implanted at a median age of 5.6 years (0.0-17.4), was analyzed and followed up to 12.2 years (median 3.7). Patients were subdivided in two groups: right (RV, n = 21) and left (LV, n = 31) ventricular pacing. To correct for age, standard deviation scores (Z-scores) for paced QRS and QTc intervals were calculated from published standard-ECG norm-values. As a measure for individual paced QRS and QTc interval changes, a regression slope coefficient (incline(i)) was calculated for each patient's course. RESULTS Mean Z-scores for paced QRS intervals at first and last follow-up were 4.7 +/- 1.2 and 4.9 +/- 0.9 for group RV, 4.4 +/- 1.1 and 4.8 +/- 1.1 for group LV. Incline(i) of paced QRS (group RV: 0.038 [-0.27-0.12], group LV: 0.147 [-0.05-0.30]; p = 0.07) and QTc intervals (group RV: 0.026 [-0.08-0.06], group LV: 0.023 [-0.04-0.09]; p = 0.63) did not differ between both groups and indicated limited interval changes over time. CONCLUSION Neither epicardial pacing of the right nor left ventricle caused disproportionate paced QRS or QTc interval increases over time. An age-related prolongation of the electrical activation unlikely causes ventricular dysfunction.
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Affiliation(s)
- Maren Tomaske
- Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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Kenny D, Walsh KP. Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:834-8. [PMID: 17584263 DOI: 10.1111/j.1540-8159.2007.00769.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The model 3830 lead (SelectSecure Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. METHODS A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. RESULTS From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1-19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8-11.4) with a median radiation dose of 83 cGycm(2). There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. CONCLUSIONS Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children.
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Affiliation(s)
- Damien Kenny
- Cardiac Department, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
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Tuzcu V, Bodtke JP, Best TH. Early Detection of Regional Myocardial Dysfunction in Paced Children With Congenital Complete Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:764-71. [PMID: 17547610 DOI: 10.1111/j.1540-8159.2007.00748.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Right ventricular apical pacing leads to global left ventricular dysfunction. Assessment of regional myocardial function may allow for earlier detection of pacing-induced myocardial remodeling. The aim of this study was to evaluate regional myocardial function in paced children with congenital complete atrioventricular block (CCAVB). METHODS We investigated regional myocardial function using strain echocardiography and tissue velocity imaging in 10 paced children with CCAVB and in 14 age-matched healthy children. Echocardiograms of the paced children were obtained during intrinsic junctional rhythm. RESULTS All patients had normal biventricular size and global function. The time from R wave to peak regional strain rate and the time from R wave to peak regional myocardial tissue velocity were measured in nine segments. The differences between maximum and minimum values were used as a measure of contraction delay (dSR and dTV). Study group patients had significantly higher dSR and dTV values compared to the control group. Mean peak strain rates and peak tissue velocities obtained from same segments were significantly decreased in the study group compared to the control group. Regional dysfunction was more prominent in the areas of ventricular pacing. No significant correlation is found between the duration of pacing (2.5-18 years) and dSR, dTV, mean peak strain rates, or mean peak tissue velocities. CONCLUSION Pacing leads to regional myocardial dysfunction that can be detected with strain echocardiography and tissue velocity imaging during intrinsic junctional rhythm in children with CCAVB. Pacing-induced regional myocardial remodeling does not seem to progress with long-term right ventricular pacing in children with CCAVB.
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Affiliation(s)
- Volkan Tuzcu
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA.
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Kim JJ, Friedman RA, Eidem BW, Cannon BC, Arora G, Smith EO, Fenrich AL, Kertesz NJ. Ventricular Function and Long-Term Pacing in Children with Congenital Complete Atrioventricular Block. J Cardiovasc Electrophysiol 2007; 18:373-7. [PMID: 17394451 DOI: 10.1111/j.1540-8167.2006.00741.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the sequela of right ventricular pacing in children with congenital complete atrioventricular block. BACKGROUND Pacing is a well-accepted therapy for patients with congenital complete atrioventricular block. The long-term sequela of right ventricular pacing in this population has not been well described. METHODS We performed a cohort study on all patients with congenital complete atrioventricular block who underwent pacemaker implantation at our institution from 1972 to 2004. Patients with associated congenital heart disease or ventricular dysfunction prior to pacemaker implantation were excluded. RESULTS A total of 63 patients were included in the study. The median age at pacemaker implantation was 6.5 years, with an average follow-up of 9.9 years. The cumulative dysfunction free survival at 20 years was 92%. In total, four patients (6%) were noted to develop LV dysfunction an average of 15.1 years after pacemaker implantation. Of 30 patients who were paced for >10 years, only three (10%) developed echocardiographic evidence of LV dysfunction. Right ventricular apex pacing and prolonged QRS duration were found to be predictive of decreased long-term LV systolic function (P < 0.05). CONCLUSIONS Left ventricular dysfunction in patients with congenital complete atrioventricular block is a rare finding, even in those who have been paced for more than 10 years. Right ventricular apex pacing and prolonged QRS duration may be associated with decreased ventricular function over time. At this time, with such a low incidence of cardiac dysfunction, right ventricular pacing should be considered an acceptable first-line therapy in this population.
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Affiliation(s)
- Jeffrey J Kim
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
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Drago F, Silvetti MS, De Santis A, Fazio G, Biancalana G, Grutter G, Rinelli G. Closed Loop Stimulation Improves Ejection Fraction in Pediatric Patients with Pacemaker and Ventricular Dysfunction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:33-7. [PMID: 17241312 DOI: 10.1111/j.1540-8159.2007.00576.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this prospective study was to evaluate the effect of the closed loop stimulation (CLS) on the ejection fraction in pediatric patients, affected by complete atrioventricular block (CAVB) or CAVB and sinus node dysfunction (SND), with a previously implanted pacemaker (PM) and ventricular dysfunction. The role of electrical therapy in the treatment of pediatric patients with congenital atrioventricular (AV) blocks has been shown. Conventional right ventricular pacing seems to affect ventricular function. Up to now, the feasibility and the long-term results of biventricular pacing in pediatric patients were not entirely clear. METHODS In eight pediatric patients with a previously implanted single or dual chamber PM, ventricular dysfunction, and CAVB or SND and CAVB, a dual chamber PM INOS(2+)-CLS (Biotronik GmbH, Berlin, Germany) was implanted. The effect of the physiological modulation of CLS pacing mode on the ejection fraction was evaluated by Echo-Doppler examination. Measurements were performed before the substitution of the old PM and for up to 2 years of follow-up. RESULTS All patients showed correct electrical parameters at implantation and during follow-up. The mean value of the ejection fraction measured before the replacement of the old PM was 36 +/- 7%, while after 2 years it was 47 +/- 1% (P < 0.003). No patient showed any worsening of the ejection fraction, while only one showed no improvement. CONCLUSIONS DDD-CLS pacing seems to improve ventricular function in pediatric patients with CAVB and/SND in spite of the use of the apical right conventional stimulation.
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Abstract
Adults with congenital heart disease constitute one of the fastest growing populations in cardiology. Pacing is an integral part of their therapy and may reduce their morbidity and mortality significantly. The current generation of pacemakers is more sophisticated and complex, and they are being utilized for indications other than conduction abnormalities, such as termination of tachycardia and improvement of heart failure. The complex anatomy and history of multiple previous surgeries in adults with congenital heart disease, however, pose many limitations and technical challenges related to the placement of a pacemaker. Unique and innovative approaches to endocardial lead placement and improved epicardial leads is making pacemaker implantation more feasible in these patients.
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Affiliation(s)
- Anjan S Batra
- Department of Pediatric Cardiology, University of California, Irvine, Children's Hospital of Orange County, Orange, CA 92868, USA.
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van Beek E, Backx A, Singh S. Cardiac resynchronization as therapy for congestive cardiac failure in children dependent on chronic cardiac pacing. Cardiol Young 2006; 16:187-9. [PMID: 16553984 DOI: 10.1017/s1047951106000163] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2005] [Indexed: 11/05/2022]
Abstract
Three patients with heart failure after chronic right ventricular apical pacing were treated with resynchronization. Biventricular pacing was used for two patients, and the other was treated with left univentricular pacing. In all patients, we observed a dramatic improvement of left ventricular dimension, function, and clinical state. We conclude that biventricular or left ventricular pacing is superior to right ventricular apical pacing in children who are pacemaker-dependent.
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Affiliation(s)
- Eugène van Beek
- Children's Hearth Centre, University Medical Centre, Nijmegen, The Netherlands.
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Nothroff J, Norozi K, Alpers V, Arnhold JO, Wessel A, Ruschewski W, Buchhorn R. Pacemaker Implantation as a Risk Factor for Heart Failure in Young Adults with Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:386-92. [PMID: 16650267 DOI: 10.1111/j.1540-8159.2006.00358.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM Complete postoperative heart block following open-heart surgery and sinus node dysfunction are indications for permanent cardiac pacing in children with congenital heart defects. The purpose of our study was to evaluate if cardiac pacing is a risk factor of heart failure during longtime follow-up of grown ups with congenital heart disease (GUCH). METHODS For an objective assessment of heart failure, NT-Pro brain natriuretic peptide (BNP) and maximal oxygen uptake index (VO2max) during the cardiopulmonary exercise testing were measured in 346 consecutive GUCH patients during a longtime follow-up examination. RESULTS Thirty-nine of these patients who had pacemaker implantation had significantly increased BNP levels (448.2 +/- 76.8 vs 123.8 +/- 9.7 pg/mL, P < 0.0001) and significantly decreased VO(2max) (22.5 +/- 0.9 vs 27.4 +/- 0.4, P < 0.0001). Heart failure in pacemaker patients was associated with significantly prolonged QRS complex durations (171.1 +/- 8.3 ms vs 108.7 +/- 1.8 ms, P < 0.0001), increased right ventricular end diastolic diameters (38.7 +/- 2.1 mm vs 27.8 +/- 0.5mm, P < 0.0001), lower heart rates at rest (69.5 +/- 1.9/min vs 82 +/- 1/min, P < 0.0001), and at exercise (140.3 +/- 5.8/min vs 163.5 +/- 1.2/min, P < 0.0001). Mean fractional shortening of the left ventricle was normal in both patient groups. CONCLUSION Pacemaker implantation may be associated with heart failure during longtime follow-up of GUCH indicated by significantly elevated BNP levels and decreased VO2max. Possible explanations are prolongation of QRS complex duration, decreased maximal heart rates during exercise, and dilatation of the right ventricle.
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Affiliation(s)
- Jörg Nothroff
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
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Barold SS, Herweg B. Right ventricular outflow tract pacing: not ready for prime-time. J Interv Card Electrophysiol 2005; 13:39-46. [PMID: 15976977 DOI: 10.1007/s10840-005-0371-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Accepted: 01/31/2005] [Indexed: 12/31/2022]
Affiliation(s)
- S Serge Barold
- Tampa General Hospital and the University of South Florida College of Medicine, Tampa, Florida 33615, USA.
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Rhee EK. Cardiac resynchronization therapy in pediatrics: Emerging technologies for emerging indications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2005; 7:399-409. [PMID: 16138959 DOI: 10.1007/s11936-005-0024-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac resynchronization therapy (CRT) has become the standard of care for the treatment of heart failure in adults with decreased ventricular function and conduction delay who remain symptomatic despite optimal medical therapy. Indications for CRT in adults include medically refractory heart failure with a QRS duration of >or=120 msec and a left ventricular end-diastolic dimension of >or=55 mm with ejection fraction <or=35%. No such consensus guidelines exist in pediatrics; however, recent preliminary data indicate that CRT is effective therapy for symptomatic heart failure in children in both the acute postoperative setting as well as in the ambulatory setting. CRT is a viable therapeutic option in children with decreased ventricular function and ventricular conduction delay. It is preferable to high-dose inotropic therapy and should be given serious consideration for the treatment of refractory heart failure prior to proceeding with heart transplantation.
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Affiliation(s)
- Edward K Rhee
- Department of Pediatric Cardiology, St. Louis Children's Hospital, MO 63110, USA.
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Barold SS, Herweg B, Sweeney MO. Minimizing right ventricular pacing. Am J Cardiol 2005; 95:966-9. [PMID: 15820164 DOI: 10.1016/j.amjcard.2004.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 12/14/2004] [Accepted: 12/14/2004] [Indexed: 11/20/2022]
Affiliation(s)
- S Serge Barold
- University of South Florida College of Medicine and Tampa General Hospital, USA.
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Abstract
Over the last years, pacing leads design and pacemaker (PM) generator size, reliability, and longevity have markedly improved, so that reliable paediatric implant can now be performed at any age with a low complication rate. Main indications include congenital and postoperative atrioventricular block (AVB) and postoperative sick sinus syndrome. Implantation of a PM is mandatory for children who are symptomatic from syncope or congestive heart failure and for those who have advanced block persisting more than 10 days after cardiac surgery. Criteria for pacing have been established in relation with the bradycardia and prophylactic pacing is recommended in children with congenital AVB and a mean heart rate <50 beats/minute. The majority of paediatric cardiologists recommend epicardial pacing in children less than 10 kg and when venous access to the heart is limited by congenital anomalies or prior operation; for older children, transvenous implantation has become the technique of choice. As heart rate is the main determinant of cardiac output at exercise in children with normal heart structures, the VVI-R mode is an alternative to dual chamber transvenous pacing in young patients. Patients with isolated sinus failure are paced in the atrium. Although the majority of patients are doing well, late complications within the paediatric population include venous thrombosis and difficulties in lead extraction. Myocardial dysfunction in children with congenital AVB is increasingly reported, but it is not determined whether it is due to the underlying disease or to right ventricular apical pacing and adverse remodelling.
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Affiliation(s)
- E Villain
- Service de cardiologie pédiatrique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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