Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients
| Autor: | Fabio Anselmo Saputo, Vincenzo Pazzano, Fabrizio Drago, Antonio Ammirati, Fabrizio Gimigliano, Chiara Mizzon, Lucilla Ravà, Massimo Stefano Silvetti, Irma Battipaglia |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Pacemaker Artificial Adolescent Systole Heart Ventricles Ventricular Septum 030204 cardiovascular system & hematology Ventricular Function Left Contractility 03 medical and health sciences QRS complex 0302 clinical medicine Imaging Three-Dimensional Physiology (medical) Internal medicine medicine Fluoroscopy Humans 030212 general & internal medicine Prospective Studies Ventricular dyssynchrony Lead (electronics) Atrioventricular Block Child Ejection fraction medicine.diagnostic_test business.industry Cardiac Pacing Artificial Stroke Volume medicine.disease Catheter Treatment Outcome Echocardiography Cardiology Female Cardiology and Cardiovascular Medicine business Atrioventricular block Follow-Up Studies |
| Zdroj: | Heart rhythm. 18(3) |
| ISSN: | 1556-3871 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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