Ventricular pacing in single ventricles-A bad combination
Anica Bulic1, Frank J Zimmerman2, Scott R Ceresnak1
1Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
Heart Rhythm
|May 23, 2017
Summary
Chronic ventricular pacing (VP) in single-ventricle patients significantly increases the risk of systolic dysfunction and heart failure. This highlights an urgent need for strategies to mitigate VP
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Electrophysiology
Background:
- Chronic ventricular pacing (VP) is linked to systolic dysfunction in children with heart block and normal hearts.
- The impact of VP in single-ventricle (SV) patients with congenital heart disease is not well understood.
Purpose of the Study:
- To investigate the long-term effects of ventricular pacing in pediatric patients with single-ventricle physiology.
Main Methods:
- Compared SV patients with >50% VP to matched non-paced SV controls.
- Assessed echocardiogram and clinical data at baseline and follow-up.
- Excluded patients without pre-pacing echocardiograms.
Main Results:
- Paced SV patients showed higher rates of moderate-to-severe systolic dysfunction (68% vs. 15%) and atrioventricular valvar regurgitation (AVVR) (55% vs. 8%).
- Paced patients were more likely to require heart failure medications (65% vs. 21%).
- Chronic VP was associated with a nearly 5-fold increased risk of death or transplantation.
Conclusions:
- Single-ventricle patients requiring chronic VP face elevated risks of ventricular dysfunction, AVVR, and mortality.
- New strategies are crucial to limit VP or enhance synchronization in this high-risk population.
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
711
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
711
01:19Conduction System of the Heart
14.1K
Autorhythmicity is a term that refers to the heart's inherent ability to generate electrical signals and instigate muscle contractions. This self-regulating conduction system within the heart consists of two key components: the pacemaker cells and specialized conducting cells.
The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...
The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...
14.1K
01:29Dysrhythmias III: Characteristics of Dysrhythmias
578
Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
578
01:13The Cardiac Cycle
99.7K
The heart beats rhythmically in a sequence called the cardiac cycle—a rapid coordination of contraction (systole) and relaxation (diastole).
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...
99.7K
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
675
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
675
01:29Disturbances in Heart Rhythm
3.4K
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
3.4K