Pacing therapy in children.

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Biomedical Engineering

Background:

• Ventricular pacing site selection is crucial in pediatric pacemaker therapy.
• Left ventricular (LV)-prioritized pacing is an emerging strategy.
• Pacing-induced ventricular dysfunction necessitates lead evaluation and repositioning.

Purpose of the Study:

• To review the outcomes of an LV-prioritized pacing strategy in pediatric patients.
• To evaluate the efficacy of ventricular lead repositioning.
• To identify predictors of ventricular lead failure.

Main Methods:

• Retrospective review of 60 pediatric patients undergoing 76 permanent pacemaker implantations (2000-2012).
• Analysis of ventricular lead failure rates, pacing properties, and ventricular function.
• Evaluation of LV-prioritized pacing and lead repositioning in specific patient groups.

Main Results:

• Freedom from ventricular lead failure was 96.3%, 86.8%, and 81.0% at 1, 3, and 5 years.
• Age and peak minimal energy threshold predicted lead failure.
• Bipolar, steroid-eluting leads showed superior pacing properties compared to non-steroid-eluting leads.
• LV lead repositioning was effective in systemic LV pacing but inconsistent in other configurations.
• LV pacing patients maintained preserved ventricular function (LV fraction shortening, 0.34±0.09).

Conclusions:

• An LV-prioritized pacing strategy yields excellent outcomes in pediatric patients, preserving ventricular function.
• Bipolar, steroid-eluting epicardial leads offer good pacing properties, even in reoperations.
• LV apex pacing is a viable alternative for pediatric patients with pacing-induced ventricular dysfunction.