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What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents?
Author(s) -
Silvetti Massimo Stefano,
Ammirati Antonio,
Palmieri Rosalinda,
Pazzano Vincenzo,
Placidi Silvia,
Ravà Lucilla,
Remoli Romolo,
Saputo Fabio Anselmo,
Verticelli Letizia,
Drago Fabrizio
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13153
Subject(s) - medicine , contractility , qrs complex , cardiology , ejection fraction , atrioventricular block , fractional shortening , ventricular dyssynchrony , ventricular outflow tract , cardiac resynchronization therapy , heart failure
Aims Right ventricular (RV) apical (RVA) pacing can induce left ventricular (LV) dyssynchrony, remodeling, and dysfunction in children with complete atrioventricular block (CAVB). We compared the functional outcome of RVA with RV alternative pacing sites (RVAPS), including para‐Hisian, septal, and outflow tract sites. Methods This is a single‐center, retrospective study. Data were collected before pacemaker implantation (transvenous leads), postoperatively, at 6 months, and at 1–2–3–4 years. Electrocardiogram evaluation included QRS duration, axis, QTc/JTc, and QTc dispersion. Echocardiographic evaluation included 2‐D/3‐D assessment of ventricular dimensions (Z‐score of LV end‐diastolic dimension), function (ejection fraction), and synchrony. Results From 2009 to 2015, 55 patients with CAVB, aged 3–17 years, with or without other congenital heart defects, underwent RVAPS (30 patients, median age 11 years) or RVA (25 patients, median 12 years). All leads were positioned into the septum. Before implantation, no significant differences in parameters were observed, except for higher Z‐score in RVAPS than in RVA. After implantation, at a median follow‐up of 2.5 (range 1–6) years, the two groups showed no significant differences in LV dimensions, contractility, and synchrony. QRS intervals of RVAPS were significantly shorter than RVA. Clinical status was good and contractility/synchrony indexes were normal or adequate in all patients. Conclusions In pediatric patients, RVAPS and RVA showed no significant differences in LV dimensions, contractility, and synchrony. Preimplantation dilated patients showed LV reverse remodeling. RVAPS demonstrated shorter QRS intervals. Therefore, septal pacing sites, either RVA or RVAPS, seem to determine good contractility and synchrony at a mid‐term follow‐up.