Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients

Massimo Stefano Silvetti; Vincenzo Pazzano; Irma Battipaglia; Fabio Anselmo Saputo; Chiara Mizzon; Fabrizio Gimigliano; Antonio Ammirati; Lucilla Ravà; Fabrizio Drago

doi:10.1016/j.hrthm.2020.12.004

Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients

Heart Rhythm. 2021 Mar;18(3):434-442. doi: 10.1016/j.hrthm.2020.12.004. Epub 2020 Dec 8.

Authors

Massimo Stefano Silvetti¹, Vincenzo Pazzano², Irma Battipaglia², Fabio Anselmo Saputo², Chiara Mizzon², Fabrizio Gimigliano², Antonio Ammirati², Lucilla Ravà³, Fabrizio Drago²

Affiliations

¹ Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart). Electronic address: mstefano.silvetti@opbg.net.
² Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart).
³ Epidemiology Institute, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.

PMID: 33307214
DOI: 10.1016/j.hrthm.2020.12.004

Abstract

Background: Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction.

Objective: The purpose of this study was to determine whether EAM-guided selective RV septal pacing preserves LV contractility/synchrony in pediatric patients with complete atrioventricular block (CAVB) and no other congenital heart defects.

Methods: Prospective analysis of children/adolescents who underwent EAM-guided selective RV pacing was performed. A 3D pacing map guided ventricular lead implantation at septal sites with narrow paced QRS. Serial echocardiograms were obtained after pacemaker implantation to monitor for function (volumes, ejection fraction [EF], global longitudinal/circumferential strain) and synchrony (interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index). Data are reported as median (25th-75th percentile).

Results: Thirty-two CAVB patients (age 9.8 [7.0-14.0] years; 11 with a previous pacing system) underwent selective RV septal pacing (13 DDD, 19 VVIR pacemaker; midseptum 22, parahisian 7, RV outflow tract 3) with narrow paced QRS (110 [100-120] ms) and low radiation exposure. Follow-up over 24 (5-33) months showed preserved LV function and synchrony, without significant differences between pacing sites (midseptum-parahisian) and mode (VVIR-DDD). EF decreased after implantation in patients without previous pacing, although values were mainly within normal limits. Three parahisian patients underwent early lead repositioning.

Conclusion: EAM-guided selective RV septal pacing is a feasible technique associated with preserved LV systolic function and synchrony and low radiation exposure in pediatric patients with CAVB.

Keywords: Cardiac pacing; Nonfluoroscopic mapping system; Pediatric age; Radiation exposure; Selective pacing; Ventricular dyssynchrony; Ventricular function.

MeSH terms

Adolescent
Atrioventricular Block / diagnosis*
Atrioventricular Block / physiopathology
Atrioventricular Block / therapy
Cardiac Pacing, Artificial / methods*
Child
Echocardiography
Female
Follow-Up Studies
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Humans
Imaging, Three-Dimensional*
Male
Pacemaker, Artificial*
Prospective Studies
Stroke Volume / physiology*
Systole
Treatment Outcome
Ventricular Function, Left
Ventricular Septum