Pediatric and Congenital EPThree-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients
Graphical abstract
Introduction
Alternative pacing sites have been proposed to prevent or reduce pacing-induced left ventricular (LV) dysfunction in children with complete atrioventricular block (CAVB).1, 2, 3 Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) guide cardiac catheter navigation and reduce fluoroscopy during electrophysiological procedures. Some experiences with the use of EAM to guide pacing lead placement in adults4,5 and children6 have been reported. Our preliminary study showed that in a limited cohort of pediatric patients, EAM-guided selective right ventricular (RV) septal pacing (SRVSP) could preserve LV function and synchrony and could determine better global longitudinal strain (GLS) than RV apical pacing at short-term follow-up.7 The aim of this study was to measure LV systolic function and synchrony in a larger cohort of children following RV septal pacing.
Section snippets
Methods
This single-center, prospective study was conducted on children and adolescents requiring permanent pacing for CAVB and systemic LV in the absence of other congenital heart defects. Patients underwent pacemaker implantation between December 2014 and February 2020 at the Cardiac Arrhythmias Unit of Bambino Gesù Children’s Hospital. Demographic data, implantation procedure data, electrocardiographic (ECG) and echocardiographic findings, complications, and clinical status at follow-up were
Results
The study included 32 pediatric patients (23 female [72%]; age 9.8 [7.0–14.0] years at the time of the procedure). Data on the first 10 patients for the first year of follow-up have already been published in our previous study.7
Eleven patients (age 10.5 [8.0–17.0] years; 7 female) were already chronically paced (9 [8–13] years): 6 from RV site, and 5 from LV sites. They all underwent new pacing system implantation because of malfunctioning ventricular leads. Baseline ECG and echocardiographic
Discussion
The present study shows the outcome of a method to implant transvenous pacing leads in SRVSP. It describes the results of EAM-guided SRVSP in children and adolescents. A 3D pacing map identified the RV septal sites with the narrowest paced QRS, and EAM guided lead implantation into or close to these sites. Data show that SRVSP preserves LV function and synchrony in children and adolescents with CAVB at short- and mid-term follow-up.
The desired PHP site was reached in one-third of patients. MS
Conclusion
In children and adolescents requiring permanent ventricular pacing for CAVB, nonfluoroscopic 3D EAM guided transvenous lead implantation at selective RV septal sites. SRVSP was associated with preserved LV systolic function and synchrony at short- and mid-term follow-up. This EAM-guided SRVSP approach allowed low radiation exposures. Further studies and longer follow-up are needed for better evaluation of this approach.
Acknowledgments
The authors thank Dr Elisa Del Vecchio for valuable collaboration in the editorial revision; Drs Luigina Porco, Ilaria Cazzoli, and Camilla Calvieri (manuscript writing); and Engineers Greta Allegretti, Roberta Annibali, and Michele Ciani, Abbott St. Jude Medical, Italy (technical assistance).
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Funding sources; The authors have no funding sources to disclose. Disclosures: The authors have no conflicts of interest to disclose.