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Pacing Therapy in Children: Repeat Left Ventricular Pacing for Preservation of Ventricular Function

Background:The importance of ventricular pacing site in pediatric pacemaker therapy has gradually become recognized. We reviewed our experience with a left ventricular (LV)-prioritized pacing strategy.Methods and Results:Between 2000 and 2012, 60 patients underwent 76 permanent pacemaker implantatio...

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Published in:Circulation Journal 2014/11/25, Vol.78(12), pp.2972-2978
Main Authors: Matsuhisa, Hironori, Oshima, Yoshihiro, Maruo, Ayako, Hasegawa, Tomomi, Tanaka, Akiko, Noda, Rei, Iwaki, Ryuma, Matsushima, Shunsuke, Tanaka, Toshikatsu, Kido, Sachiko
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Language:English
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Summary:Background:The importance of ventricular pacing site in pediatric pacemaker therapy has gradually become recognized. We reviewed our experience with a left ventricular (LV)-prioritized pacing strategy.Methods and Results:Between 2000 and 2012, 60 patients underwent 76 permanent pacemaker implantations. Eight of the 29 reoperations involved ventricular lead repositioning for pacing-induced ventricular dysfunction. Freedom from ventricular lead failure was 96.3%, 86.8%, and 81.0% at 1, 3, and 5 years, respectively. The independent predictors of ventricular lead failure were age (P=0.026) and peak minimal energy threshold within 6 months (P=0.035). At the measured points, redo bipolar, steroid-eluting leads had significantly better pacing properties than did redo non-steroid-eluting, screw-in leads (P=0.0009–0.03). Ventricular lead repositioning was effective in the 5 patients with systemic LV pacing, whereas its efficacy was inconsistent in patients with single-ventricle or systemic right ventricular (RV) pacing. At a median follow-up of 59 months, the 28 patients with LV pacing had preserved ventricular function (LV fraction shortening, 0.34±0.09).Conclusions:The outcome of this LV-prioritized pacing strategy in pediatric patients was excellent, demonstrating preserved ventricular function. Bipolar, steroid-eluting, epicardial pacing leads achieved good pacing properties, even in reoperation patients. In children with systemic LV and RV pacing-induced ventricular dysfunction, a conversion to LV apex pacing was an attractive alternative to cardiac resynchronization therapy. (Circ J 2014; 78: 2972–2978)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-14-0534