What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents?

Massimo Stefano Silvetti, Antonio Ammirati, Rosalinda Palmieri, Vincenzo Pazzano, Silvia Placidi, Lucilla Ravà, Romolo Remoli, Fabio Anselmo Saputo, Letizia Verticelli, Fabrizio Drago

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)995-1003
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume40
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

Fingerprint

Ventricular Remodeling
Atrioventricular Block
Congenital Heart Defects
Left Ventricular Dysfunction
Electrocardiography
Retrospective Studies
Pediatrics

Keywords

  • alternative pacing sites
  • cardiac pacing
  • children
  • congenital atrioventricular block
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents? / Silvetti, Massimo Stefano; Ammirati, Antonio; Palmieri, Rosalinda; Pazzano, Vincenzo; Placidi, Silvia; Ravà, Lucilla; Remoli, Romolo; Saputo, Fabio Anselmo; Verticelli, Letizia; Drago, Fabrizio.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 40, No. 9, 01.09.2017, p. 995-1003.

Research output: Contribution to journalArticle

@article{66636bc3993a420db94ce27cb2bfdf83,
title = "What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents?",
abstract = "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.",
keywords = "alternative pacing sites, cardiac pacing, children, congenital atrioventricular block, heart failure",
author = "Silvetti, {Massimo Stefano} and Antonio Ammirati and Rosalinda Palmieri and Vincenzo Pazzano and Silvia Placidi and Lucilla Rav{\`a} and Romolo Remoli and Saputo, {Fabio Anselmo} and Letizia Verticelli and Fabrizio Drago",
year = "2017",
month = "9",
day = "1",
doi = "10.1111/pace.13153",
language = "English",
volume = "40",
pages = "995--1003",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents?

AU - Silvetti, Massimo Stefano

AU - Ammirati, Antonio

AU - Palmieri, Rosalinda

AU - Pazzano, Vincenzo

AU - Placidi, Silvia

AU - Ravà, Lucilla

AU - Remoli, Romolo

AU - Saputo, Fabio Anselmo

AU - Verticelli, Letizia

AU - Drago, Fabrizio

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - alternative pacing sites

KW - cardiac pacing

KW - children

KW - congenital atrioventricular block

KW - heart failure

UR - http://www.scopus.com/inward/record.url?scp=85028303101&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028303101&partnerID=8YFLogxK

U2 - 10.1111/pace.13153

DO - 10.1111/pace.13153

M3 - Article

AN - SCOPUS:85028303101

VL - 40

SP - 995

EP - 1003

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 9

ER -