Cardiac Pacing and Defibrillation in Children and Young Adults

Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives.cardiac-resynchronization therapy, complete AV block, pacemaker, third-degree AV block, young adults | INTRODUCTIONThird-degree atrioventricular block (AVB) or complete AV block (CAVB) is an arrhythmia with complete dissociation between atrial and ventricular activity, without evidence of AV conduction (Figure 1). According to American or European Guidelines, 1 a permanent pacemaker (PM) is indicated in CAVB, provided that the cause is neither transient nor reversible. Given their life expectancy, significant challenges may be faced when evaluating children, young or middle-aged adults with CAVB, since choosing the best pacing strategy is of paramount importance. Permanent CAVB requires permanent right ventricular (RV) stimulation, which in some cases may lead to ventricular dysfunction due to ventricular

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“…Regardless of the pacing strategy, future growth of the patient must always be in mind during lead implantation. 65…”

Section: Acquired Atrioventricular Blockmentioning

confidence: 99%

Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives

Cioffi

Gasperetti

Tersalvi

et al. 2021

Cardiovasc electrophysiol

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“…There was no significant difference in ejection fraction improvement among the different heart disease groups (congenital heart disease, cardiomyopathy, and complete heart block). Several patients in the study were ultimately removed from cardiac transplant waiting lists, suggesting that BiV therapy could be possibly used to prevent or delay end-stage heart failure (13,14).…”

Section: Implantable Cardioverter-defibrillators In the Pediatric Popmentioning

confidence: 99%

Cardiac devices in the pediatric population: an overview of the indications and complications

Sovic

Penninti

2019

Electron J Gen Med

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Pacemakers, implantable cardioverter-defibrillators, and biventricular pacemakers have similar uses in the pediatric population as they do in the adult population. Pacemaker indications are similar in adults and children: sinus node dysfunction and second or third degree atrioventricular blocks. Pacemaker candidacy in pediatrics, however, must take into account the patient's symptom burden rather than absolute heart rate cutoffs. Normal ranges for heart rates in children are also different than adults and vary depending on a child's age. The guidelines for implantable cardioverterdefibrillators likewise are similar to those for adults, being indicated as secondary prevention for sudden cardiac death survivors and as primary prevention in select patients who experience ventricular tachycardia. However, there are currently no specific recommendations for these devices in children with congenital heart defects. Likewise, though there is new promising research, there are currently no specific indications for biventricular pacing in children. The potential complications of pediatric cardiac devices relate to the different heart rate requirements children have compared to adults and the general procedural risks associated with cardiac implants (infection, bleeding, device failure). Despite the recent growth in the use of cardiac devices in children, there is still much room for continued research into the potential indications for and complications from these tools in the pediatric population. Unfortunately, the lack of evidence holds true not only for South America but worldwide. Research studies conducted in South America would give a better understanding about the demographic differences in terms of outcomes.

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“…5 After surgical treatment for tetralogy of Fallot, the incidence of ventricular arrhythmia has been reported to be as high as 1.2% to 3.0% per decade. 6 TGA is associated with a higher risk for SCD, which can result from malignant ventricular arrhythmia or rapid ventricular response to atrial fibrillation, and also with an increased frequency of abnormalities of the conduction system, which have been reported in as much as 25% of children with TGA. 6,7 Patients with CHD surviving to adult age present also a relatively high incidence of ventricular arrhythmia, approximately 0.1% to 0.2% per year, and implantation of an ICD device in these patients can be life-saving.…”

Section: Sudden Cardiac Death In Childhoodmentioning

confidence: 99%

“…6 TGA is associated with a higher risk for SCD, which can result from malignant ventricular arrhythmia or rapid ventricular response to atrial fibrillation, and also with an increased frequency of abnormalities of the conduction system, which have been reported in as much as 25% of children with TGA. 6,7 Patients with CHD surviving to adult age present also a relatively high incidence of ventricular arrhythmia, approximately 0.1% to 0.2% per year, and implantation of an ICD device in these patients can be life-saving. 8 In many cases, a genetic predisposition exposes the children to a higher risk of various heart diseases.…”

Section: Sudden Cardiac Death In Childhoodmentioning

confidence: 99%

Modern Technology for Prevention of Sudden Cardiac Death – a Clinical Update on Device Therapy in Children with Congenital Heart Diseases

Casu

2018

Journal of Cardiovascular Emergencies

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Sudden cardiac death in children is one of the most devastating conditions that can be encountered in acute cardiac care. Intracardiac device therapy, providing prompt and effective treatment in malignant ventricular arrhythmia or in severe conduction abnormalities, is a promising tool to reduce the incidence of this fatal condition. However, the implementation of device-based therapy in the pediatric population is currently limited by the lack of clinical studies on large number of subjects. As a result, indications for device therapy in pediatric patients are still unclear in many circumstances. There are also several particularities related to device implantation in pediatric age, such as the somatic growth leading to a mismatch between chamber size and lead length, or the difficulties of implantation technique in children with small body weight. This study aims to present an update on the current advantages and limitations of device-based therapy for treating severe malignant arrhythmia or conduction disorders in children at risk for sudden cardiac death.

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Cardiac Pacing and Defibrillation in Children and Young Adults

Cited by 13 publications

References 40 publications

Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives

Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives

Cardiac devices in the pediatric population: an overview of the indications and complications

Modern Technology for Prevention of Sudden Cardiac Death – a Clinical Update on Device Therapy in Children with Congenital Heart Diseases

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