title: Managed ventricular pacing in pediatric patients and patients with congenital heart disease.
abstract: Ventricular dyssynchrony induced by ventricular pacing (VP) may predispose patients to congestive heart failure. The detrimental effects of VP are directly related to the cumulative percentage of VP (Cum%VP). Managed VP (MVP) is a novel pacing algorithm developed to minimize unnecessary VP by uncoupling atrial pacing from VP. This retrospective analysis assessed the feasibility of using MVP in pediatric patients and patients with congenital heart disease (CHD). A multicenter review evaluated all pediatric patients <22 years old and older patients with CHD that had an implanted device using a MVP algorithm. Primary outcome variables were Cum%VP and adverse events. A subgroup analysis evaluated patients that had a DDD(R) pacemaker before a MVP device and compared Cum%VP before and after initiation of MVP. From 6 centers 62 patients (mean age 21.5 +/- 9.6 years) were included; 64% had CHD. With a MVP device, mean Cum%VP was 4.3 +/- 14.6% (range 0 to 83.7): Eleven patients were eligible for subgroup analysis. Compared with DDD(R), Cum%VP significantly decreased with MVP (67.1 +/- 29.4% vs 9.2 +/- 24.8%, p = 0.002). One MVP-related adverse event occurred; a patient with intermittent atrioventricular block had symptoms with frequent nonconducted atrial depolarizations and was reprogrammed to DDD. In conclusion, MVP can be used safely and can significantly reduce unnecessary VP in pediatric patients and patients with CHD.
authors.affiliation: Children's National Medical Center, Washington, DC, USA. jkaltman@cnmc.org
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Ro
authors.forename: Frank
authors.initials: F
authors.lastname: Zimmerman
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Moak
authors.forename: Michael
authors.initials: M
authors.lastname: Epstein
authors.forename: Ilana J
authors.initials: IJ
authors.lastname: Zeltser
authors.forename: Maully J
authors.initials: MJ
authors.lastname: Shah
authors.forename: Karen
authors.initials: K
authors.lastname: Buck
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Vetter
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005240:Feasibility Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome