Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study

Circulation. 2013 Feb 5;127(5):613-23. doi: 10.1161/CIRCULATIONAHA.112.115428. Epub 2012 Dec 30.

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Atrioventricular Block / pathology*
  • Atrioventricular Block / physiopathology
  • Atrioventricular Block / therapy*
  • Cardiac Pacing, Artificial / methods*
  • Child
  • Cross-Sectional Studies
  • Electrocardiography
  • Female
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology*
  • Heart Ventricles / physiopathology
  • Humans
  • Male
  • Models, Cardiovascular
  • Pacemaker, Artificial*
  • Radiography, Thoracic
  • Retrospective Studies
  • Stroke Volume / physiology
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology