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Closed loop stimulation improves ejection fraction in pediatric patients with pacemaker and ventricular dysfunction

Fabrizio Drago1, Massimo S Silvetti, Antonella De Santis

  • 1Cardiology Division, Bambin Gesù Hospital, Rome, Italy. drago@opbg.net

Pacing and Clinical Electrophysiology : PACE
|January 24, 2007
PubMed

Insights

Closed loop stimulation (CLS) improved ejection fraction in pediatric patients with heart block and ventricular dysfunction. This biventricular pacing approach offers a promising alternative to conventional pacing, enhancing cardiac function over two years.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Congenital atrioventricular blocks (CAVB) and sinus node dysfunction (SND) can lead to ventricular dysfunction in pediatric patients.
  • Conventional right ventricular pacing may negatively impact ventricular function.
  • The long-term efficacy of biventricular pacing in pediatric populations remains under investigation.

Purpose of the Study:

  • To assess the impact of closed loop stimulation (CLS) on ejection fraction in pediatric patients with CAVB or CAVB and SND.
  • To evaluate the feasibility and long-term outcomes of biventricular pacing in this cohort.

Main Methods:

  • Eight pediatric patients with pre-existing pacemakers, ventricular dysfunction, and CAVB or SND underwent implantation of a dual-chamber pacemaker with CLS functionality.
  • Ejection fraction was assessed using Echo-Doppler before pacemaker replacement and followed for up to two years.

Main Results:

  • All patients maintained correct electrical parameters throughout the study.
  • Mean ejection fraction improved significantly from 36% pre-replacement to 47% at two-year follow-up (P < 0.003).
  • No patient experienced worsening of ejection fraction; one patient showed no improvement.

Conclusions:

  • DDD-CLS pacing demonstrates potential for improving ventricular function in pediatric patients with CAVB and/or SND.
  • This pacing strategy appears beneficial despite the continued use of conventional right ventricular apical stimulation.
Abstract

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