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A Pilot Study Assessing ECG versus ECHO Ventriculoventricular Optimization in Pediatric Resynchronization Patients.

Rajesh Punn1, Debra Hanisch1, Kara S Motonaga1

  • 1Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.

Journal of Cardiovascular Electrophysiology
|October 31, 2015
PubMed
Summary

Electrocardiogram (ECG) optimization of cardiac resynchronization therapy (CRT) in children is as effective as echocardiography (ECHO) but significantly faster and less expensive. This study compared both methods in pediatric patients.

Keywords:
cardiac resynchronization therapyoptimizationpediatric

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Area of Science:

  • Pediatric Cardiology
  • Cardiac Electrophysiology
  • Medical Device Optimization

Background:

  • Cardiac resynchronization therapy (CRT) management is established in adults, but pediatric applications present unique challenges.
  • Echocardiography (ECHO) is used for optimizing mechanical synchrony, but it is time-intensive and has reproducibility issues.
  • Electrocardiogram (ECG) methods offer a quicker assessment of electrical synchrony but require further study in children.

Purpose of the Study:

  • To compare the efficacy and efficiency of echocardiography (ECHO) versus electrocardiogram (ECG) methods for optimizing cardiac resynchronization therapy (CRT) in pediatric patients.
  • To evaluate differences in time, cost, and clinical outcomes between ECHO and ECG optimization techniques.

Main Methods:

  • A prospective, single-center, pediatric cross-over trial involving 19 patients undergoing CRT.
  • Patients were randomly assigned to either ECHO or ECG optimization for 6 months, then crossed over to the other method for 6 months.
  • ECG optimization focused on shortest QRSD, while ECHO optimization targeted the lowest dyssynchrony index; various clinical and imaging parameters were assessed.

Main Results:

  • ECG optimization was significantly faster (9 ± 1 min) than ECHO optimization (68 ± 13 min) (P < 0.01).
  • ECG optimization resulted in lower costs (average savings of $4,400 ± $700).
  • No significant differences were observed in other assessed outcomes, including ejection fraction, cardiac index, or quality of life.

Conclusions:

  • In this pilot study, ECG optimization of CRT in children was not inferior to ECHO optimization.
  • ECG-based CRT optimization offers a more time-efficient and cost-effective approach compared to ECHO in pediatric patients.
  • ECG optimization represents a viable alternative for synchrony assessment in pediatric CRT.