title: Pacing therapy in children.
abstract: BACKGROUND
  The importance of ventricular pacing site in pediatric pacemaker therapy has gradually become recognized. We reviewed our experience with a left ventricular (LV)-prioritized pacing strategy. METHODS AND RESULTS: Between 2000 and 2012, 60 patients underwent 76 permanent pacemaker implantations. Eight of the 29 reoperations involved ventricular lead repositioning for pacing-induced ventricular dysfunction. Freedom from ventricular lead failure was 96.3%, 86.8%, and 81.0% at 1, 3, and 5 years, respectively. The independent predictors of ventricular lead failure were age (P=0.026) and peak minimal energy threshold within 6 months (P=0.035). At the measured points, redo bipolar, steroid-eluting leads had significantly better pacing properties than did redo non-steroid-eluting, screw-in leads (P=0.0009-0.03). Ventricular lead repositioning was effective in the 5 patients with systemic LV pacing, whereas its efficacy was inconsistent in patients with single-ventricle or systemic right ventricular (RV) pacing. At a median follow-up of 59 months, the 28 patients with LV pacing had preserved ventricular function (LV fraction shortening, 0.34±0.09).
  
  
  CONCLUSIONS
  The outcome of this LV-prioritized pacing strategy in pediatric patients was excellent, demonstrating preserved ventricular function. Bipolar, steroid-eluting, epicardial pacing leads achieved good pacing properties, even in reoperation patients. In children with systemic LV and RV pacing-induced ventricular dysfunction, a conversion to LV apex pacing was an attractive alternative to cardiac resynchronization therapy.
authors.affiliation: Department of Cardiovascular Surgery, Kobe Children's Hospital.
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuhisa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Oshima
authors.forename: Ayako
authors.initials: A
authors.lastname: Maruo
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Rei
authors.initials: R
authors.lastname: Noda
authors.forename: Ryuma
authors.initials: R
authors.lastname: Iwaki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsushima
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kido
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology; D012086:Reoperation; D012141:Respiratory Tract Infections / Q000401:mortality; D012189:Retrospective Studies; D056346:Sternotomy; D013908:Thoracotomy; D013997:Time Factors; D055815:Young Adult