title: Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study.
abstract: BACKGROUND
  We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing.
  
  
  RESULTS
  One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction.
  
  
  CONCLUSIONS
  The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
authors.affiliation: Children's Heart Center, University Hospital Motol, V Úvalu 84, 150 06 Prague 5, Czech Republic. jan.janousek@lfmotol.cuni.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Janoušek
authors.forename: Irene E
authors.initials: IE
authors.lastname: van Geldorp
authors.forename: Sylvia
authors.initials: S
authors.lastname: Krupičková
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Kelly
authors.initials: K
authors.lastname: Nugent
authors.forename: Maren
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authors.lastname: Tomaske
authors.forename: Andreas
authors.initials: A
authors.lastname: Früh
authors.forename: Jan
authors.initials: J
authors.lastname: Elders
authors.forename: Anita
authors.initials: A
authors.lastname: Hiippala
authors.forename: Gunter
authors.initials: G
authors.lastname: Kerst
authors.forename: Roman A
authors.initials: RA
authors.lastname: Gebauer
authors.forename: Peter
authors.initials: P
authors.lastname: Kubuš
authors.forename: Patrick
authors.initials: P
authors.lastname: Frias
authors.forename: Fulvio
authors.initials: F
authors.lastname: Gabbarini
authors.forename: Sally-Ann
authors.initials: SA
authors.lastname: Clur
authors.forename: Bert
authors.initials: B
authors.lastname: Nagel
authors.forename: Javier
authors.initials: J
authors.lastname: Ganame
authors.forename: John
authors.initials: J
authors.lastname: Papagiannis
authors.forename: Jan
authors.initials: J
authors.lastname: Marek
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Tisma-Dupanovic
authors.forename: Sabrina
authors.initials: S
authors.lastname: Tsao
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Nürnberg
authors.forename: Christopher
authors.initials: C
authors.lastname: Wren
authors.forename: Mark
authors.initials: M
authors.lastname: Friedberg
authors.forename: Maxime
authors.initials: M
authors.lastname: de Guillebon
authors.forename: Julia
authors.initials: J
authors.lastname: Volaufova
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
mesh_terms: D000293:Adolescent; D054537:Atrioventricular Block / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D010138:Pacemaker, Artificial; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology