Progressive QRS Duration and Ventricular Dysfunction in Pediatric Patients with Chronic Ventricular Pacing

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Pacemakers are crucial for heart block, but ventricular pacing risks ventricular dysfunction.
• Understanding factors predicting dysfunction in pediatric patients is vital.

Purpose of the Study:

• To identify patient and device characteristics linked to ventricular dysfunction in pediatric patients with chronic ventricular pacing.
• To analyze the association between QRS duration changes and ventricular dysfunction.

Main Methods:

• Retrospective cohort study of 82 pediatric patients with heart block and chronic ventricular pacing.
• Analysis of patient, ECG, and device data, including longitudinal ECG and echocardiogram parameters.
• Evaluation of factors associated with ventricular dysfunction over a median follow-up of 6.1 years.

Main Results:

• 18% of patients developed ventricular dysfunction.
• Greater current QRS duration and increased QRS duration over time (ΔQRS) were associated with dysfunction.
• QRS duration >162 ms increased dysfunction risk 5.8-fold; ΔQRS was also significant (p=0.01).

Conclusions:

• Absolute and change in paced QRS duration are independent predictors of long-term ventricular dysfunction in pediatric patients.
• Patients with high-risk QRS duration metrics may benefit from enhanced echocardiographic surveillance.
• Further research into alternative pacing strategies like His bundle or biventricular pacing is warranted.