Permanent cardiac pacing in children: choosing the optimal pacing site: a multicenter study

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Cardiac Mechanics

Background:

• Children requiring permanent pacing often have atrioventricular block and structurally normal hearts.
• The impact of ventricular pacing site on left ventricular (LV) function and synchrony in pediatric populations is not fully understood.

Purpose of the Study:

• To evaluate how different ventricular pacing sites affect LV synchrony and function in children.
• To identify optimal pacing sites for preserving cardiac pump function in pediatric patients requiring permanent pacing.

Main Methods:

• Cross-sectional study of 178 children (<18 years) from 21 centers with permanent pacing.
• Analysis of pacing sites including right ventricular (RV) outflow tract, RV lateral wall, RV apex, RV septum, LV apex, LV midlateral wall, and LV base.
• Assessment of LV synchrony, pump function, and contraction efficiency in relation to pacing site.

Main Results:

• Pacing site significantly affected LV synchrony, pump function, and contraction efficiency.
• Pacing at the LV apex or LV midlateral wall demonstrated superior LV synchrony and function.
• Pacing from the RV outflow tract/lateral RV was associated with significantly decreased LV function (LV ejection fraction <45%).
• LV apex/LV midlateral wall pacing was linked to preserved LV function (LV ejection fraction ≥55%).
• LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031).

Conclusions:

• The ventricular pacing site critically influences mechanical synchrony, efficiency, and pump function in children needing lifelong pacing.
• Pacing the LV apex or LV midlateral wall holds the greatest potential to prevent pacing-induced reductions in cardiac pump function.
• Optimizing pacing site selection is crucial for long-term cardiac health in pediatric patients.