Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-27T14:30:08.546Z Has data issue: false hasContentIssue false

To go left or right? Driving towards the best direction in paediatric pacing

Published online by Cambridge University Press:  08 June 2022

Massimo Stefano Silvetti*
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Luigina Porco
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Ilaria Tamburri
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Marta Campisi
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Fabrizio Gimigliano
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Fabio Anselmo Saputo
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Chiara Mizzon
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Corrado Di Mambro
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Sonia Albanese
Affiliation:
Cardiac Surgery Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Lucilla Ravà
Affiliation:
Epidemiology Institute, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
Fabrizio Drago
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Italy
*
Author for correspondence: Massimo Stefano Silvetti, MD, Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, Rome 00165, Italy. Tel. +39 06 68593354; Fax +39 06 68594841. E-mail: mstefano.silvetti@opbg.net

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.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Karpawich, PP, Rabah, R, Haas, JE. Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. Pacing Clin Electrophysiol 1999; 22: 13721377.CrossRefGoogle ScholarPubMed
Kim, JJ, Friedman, RA, Eidem, BW, et al. Ventricular function and long-term pacing in children with congenital complete atrioventricular block. J Cardiovasc Electrophysiol 2007; 18: 373377.CrossRefGoogle ScholarPubMed
Moak, JP, Barron, KS, Hougen, TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol 2001; 37: 238242.CrossRefGoogle ScholarPubMed
Silvetti, MS, Drago, F, Ravà, L. Determinants of early dilated cardiomyopathy in neonates with congenital complete atrioventricular block. Europace 2010; 12: 13161321.CrossRefGoogle ScholarPubMed
Gebauer, RA, Tomek, V, Kubus, P, et al. Differential effects of the site of permanent epicardial pacing on left ventricular synchrony and function in the young: implications for lead placement. Europace 2009; 11: 16541659.CrossRefGoogle Scholar
Janoušek, J, van Geldorp, IE, Krupičková, S, et al. Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study. Circulation 2013; 127: 613623.CrossRefGoogle ScholarPubMed
Vanagt, WY, Verbeek, XA, Delhaas, T, et al. Acute hemodynamic benefit of left ventricular apex pacing in children. Ann Thorac Surg 2005; 79: 932936.CrossRefGoogle ScholarPubMed
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: 305314.CrossRefGoogle ScholarPubMed
Silvetti, MS, Ammirati, A, Placidi, S, Di Mambro, C, Ravà, L, Drago, F. Left ventricular pacing in neonates and infants with isolated congenital complete or advanced atrioventricular block: short and medium-term outcome. Europace 2015; 17: 603610.CrossRefGoogle ScholarPubMed
Silvetti, MS, Muzi, G, Unolt, M, et al. Left Ventricular (LV) pacing in newborns and infants: echo assessment of LV systolic function and synchrony at 5-year follow-up. PACE 2020; 43: 535541.CrossRefGoogle Scholar
Karpavich, PP, Singh, H, Zelin, K. Optimizing paced ventricular function in patients with and without repaired congenital heart disease by contractility-guided lead implant. PACE 2015; 38: 5462.CrossRefGoogle Scholar
Silvetti, MS, Battipaglia, I, Pazzano, V, et al. Electroanatomic mapping-guided localization of alternative right ventricular septal pacing sites in children. Pacing Clin Electrophysiol 2018; 41: 12041211.CrossRefGoogle ScholarPubMed
Silvetti, MS, Pazzano, V, Battipaglia, I, et al. 3D-guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in paediatric patients. Heart Rhythm 2021; 18: 434442.CrossRefGoogle Scholar
Brignole, M, Auricchio, A, Baron-Esquivias, G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013; 15: 10701118.Google Scholar
Van der Hulst, AE, Delgado, V, Blom, NA, et al. Cardiac resynchronization therapy in paediatric and congenital heart disease patients. Eur Heart J 2011; 32: 22362246.CrossRefGoogle ScholarPubMed
Marcus, KA, Mavinkurve-Groothuis, AM, Barends, M, Reference values for myocardial two-dimensional strain echocardiography in a healthy pediatric and young adult cohort. J Am Soc Echocardiogr 2011; 24: 625636.CrossRefGoogle Scholar
Kertesz, NJ, Friedman, RA, Colan, SD, et al. Left ventricular mechanics and geometry in patients with congenital complete atrioventricular block. Circulation 1997; 96: 34303435.CrossRefGoogle ScholarPubMed
Silvetti, MS, Ammirati, A, Palmieri, R, et al. What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents? PACE 2017; 40: 9951003.CrossRefGoogle ScholarPubMed
Villain, E, Coastedoat-Chalumeau, N, Marijon, E, Boudjemline, Y, Piette, JC, Bonnet, D. Presentation and prognosis of complete atrioventricular block in childhood, according to maternal antibody status. J Am Coll Cardiol 2006; 48: 16821687.CrossRefGoogle ScholarPubMed
Udink ten Cate, FE, Breur, JM, Cohen, MI, et al. Dilated cardiomyopathy in isolated congenital complete atrioventricular block: early and long-term risk in children. J Am Coll Cardiol 2001; 37: 11291134.CrossRefGoogle ScholarPubMed