Single lead VDD pacing in children with complete heart block

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Medical Devices

Background:

• Complete heart block in children necessitates pacing for survival and quality of life.
• Traditional dual-chamber pacing systems can be complex to implant and manage in pediatric populations.

Purpose of the Study:

• To assess the clinical efficacy and reliability of transvenous single lead VDD pacing in pediatric patients with complete heart block.
• To evaluate the performance of VDD pacing in terms of sensing, thresholds, and atrioventricular (AV) synchrony.

Main Methods:

• A case series design was employed, involving nine children with complete heart block requiring VDD pacing.
• Patients underwent implantation of VDD single lead pacing systems and were followed for six months with clinical assessments, device interrogations, exercise testing, Holter monitoring, and echocardiography.

Main Results:

• The procedure demonstrated acceptable times and low pacing thresholds, with good P wave sensing amplitudes.
• High percentages of atrioventricular synchronous pacing were achieved (mean >96%), with minimal sensing failures (<1%).
• A significant increase in resting cardiac output (24%) was observed in VDD mode compared to VVIR mode.

Conclusions:

• Transvenous single lead VDD pacing is an effective and reliable method for achieving physiological, rate-responsive AV synchronous pacing in children with complete heart block.
• This approach represents a viable alternative to dual lead pacing systems, potentially simplifying management and improving outcomes.