Multisite Pacing for Heart Failure Associated With Left Ventricular Apical Pacing in Congenital Heart Disease

Koubský, Karel; Kovanda, Jan; Ložek, Miroslav; Tomek, Viktor; Jičínský, Michal; Gebauer, Roman; Kubuš, Peter; Janoušek, Jan

doi:10.1016/j.jacep.2022.03.016

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…In CHD and AVB patients, class II a recommendations for physiological pacing are: CRT in the presence of systemic left ventricle dyssynchrony (QRS duration > 3 Z score) and EF < 45% [61,62]; apical pacing in single ventricle [63]; fusion-based pacing in RV dysfunction and right bundle branch block (RBBB) [64]; CSP in congenitally corrected transposition of the great arteries (CCTGA) with AVB [65][66][67][68]. In CCTGA, the subpulmonary ventricle is the anatomical LV, and the conduction system found on the endocardial subpulmonary ventricle surface is the LBB, with its anterior and posterior fascicles.…”

Section: Physiologic Pacingmentioning

confidence: 99%

New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice?

Silvetti,

Colonna,

Gabbarini

et al. 2024

JCDD

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Guidelines are important tools to guide the diagnosis and treatment of patients to improve the decision-making process of health professionals. They are periodically updated according to new evidence. Four new Guidelines in 2021, 2022 and 2023 referred to pediatric pacing and defibrillation. There are some relevant changes in permanent pacing. In patients with atrioventricular block, the heart rate limit in which pacemaker implantation is recommended was decreased to reduce too-early device implantation. However, it was underlined that the heart rate criterion is not absolute, as signs or symptoms of hemodynamically not tolerated bradycardia may even occur at higher rates. In sinus node dysfunction, symptomatic bradycardia is the most relevant recommendation for pacing. Physiological pacing is increasingly used and recommended when the amount of ventricular pacing is presumed to be high. New recommendations suggest that loop recorders may guide the management of inherited arrhythmia syndromes and may be useful for severe but not frequent palpitations. Regarding defibrillator implantation, the main changes are in primary prevention recommendations. In hypertrophic cardiomyopathy, pediatric risk calculators have been included in the Guidelines. In dilated cardiomyopathy, due to the rarity of sudden cardiac death in pediatric age, low ejection fraction criteria were demoted to class II. In long QT syndrome, new criteria included severely prolonged QTc with different limits according to genotype, and some specific mutations. In arrhythmogenic cardiomyopathy, hemodynamically tolerated ventricular tachycardia and arrhythmic syncope were downgraded to class II recommendation. In conclusion, these new Guidelines aim to assess all aspects of cardiac implantable electronic devices and improve treatment strategies.

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Section: Physiologic Pacingmentioning

confidence: 99%

New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice?

Silvetti,

Colonna,

Gabbarini

et al. 2024

JCDD

View full text Add to dashboard Cite

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Lead Management in Patients with Congenital Heart Disease

Dasgupta

Mah

2023

Cardiac Electrophysiology Clinics

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Left ventricular apical pacing-induced heart failure in a child after congenital heart surgery: a case report

De Wolf,

van der Palen,

ten Harkel

et al. 2024

European Heart Journal - Case Reports

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Background Left ventricular apical pacing (LVAP) is considered to preserve left ventricular (LV) systolic function in both patients with and without congenital heart disease. However, sporadic LVAP-associated cardiac dysfunction in children with complex structural heart disease was recently reported. We present the case of a 2.5-year-old child with complex congenital heart disease and LVAP-induced cardiomyopathy. Case summary Corrective surgery for double outlet right ventricle, subpulmonary ventricular septal defect and transposition of the great arteries was done at the age of 1.5 months. Late complete atrioventricular block occurred, necessitating VVI pacemaker insertion with LV apical epicardial leads. He presented with heart failure and dilated cardiomyopathy 1.5 years after pacemaker insertion and required persistent circulatory support with intravenous inotropes. Speckle tracking echocardiography (STE) identified an important LV apical to basal dyssynchrony. After excluding any coronary artery involvement, cardiac resynchronization therapy was performed. STE guided lead placement resulted in improved LV contraction synchrony. Cardiac function recovered progressively in combination with oral heart failure medication and is almost normal at 10-month follow-up. Discussion Right ventricular pacing is a well-known cause of pacing-induced cardiomyopathy. The LV apex and LV free wall are thought to be most optimal locations for ventricular pacing in children. However, LVAP can also be the cause of a pacing-induced cardiomyopathy and decreased systolic LV function in children with complex congenital heart disease due to lack of LV contraction synchrony. Cardiac resynchronization therapy can reverse this LV dysfunction and remodeling.

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Multisite Pacing for Heart Failure Associated With Left Ventricular Apical Pacing in Congenital Heart Disease

Cited by 3 publications

References 3 publications

New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice?

New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice?

Lead Management in Patients with Congenital Heart Disease

Left ventricular apical pacing-induced heart failure in a child after congenital heart surgery: a case report

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