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Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients

  • Massimo Stefano Silvetti
    Correspondence
    Address reprint requests and correspondence: Dr Massimo Stefano Silvetti, Cardiac Arrhythmias/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS, Via Torre di Palidoro 1, 00050 Palidoro-Fiumicino, Rome, Italy.
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Vincenzo Pazzano
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Irma Battipaglia
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Fabio Anselmo Saputo
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Chiara Mizzon
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Fabrizio Gimigliano
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Antonio Ammirati
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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  • Lucilla Ravà
    Affiliations
    Epidemiology Institute, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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  • Fabrizio Drago
    Affiliations
    Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
    Search for articles by this author
Published:December 07, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.12.004

      Background

      Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction.

      Objective

      The purpose of this study was to determine whether EAM-guided selective RV septal pacing preserves LV contractility/synchrony in pediatric patients with complete atrioventricular block (CAVB) and no other congenital heart defects.

      Methods

      Prospective analysis of children/adolescents who underwent EAM-guided selective RV pacing was performed. A 3D pacing map guided ventricular lead implantation at septal sites with narrow paced QRS. Serial echocardiograms were obtained after pacemaker implantation to monitor for function (volumes, ejection fraction [EF], global longitudinal/circumferential strain) and synchrony (interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index). Data are reported as median (25th–75th percentile).

      Results

      Thirty-two CAVB patients (age 9.8 [7.0–14.0] years; 11 with a previous pacing system) underwent selective RV septal pacing (13 DDD, 19 VVIR pacemaker; midseptum 22, parahisian 7, RV outflow tract 3) with narrow paced QRS (110 [100–120] ms) and low radiation exposure. Follow-up over 24 (5–33) months showed preserved LV function and synchrony, without significant differences between pacing sites (midseptum–parahisian) and mode (VVIR-DDD). EF decreased after implantation in patients without previous pacing, although values were mainly within normal limits. Three parahisian patients underwent early lead repositioning.

      Conclusion

      EAM-guided selective RV septal pacing is a feasible technique associated with preserved LV systolic function and synchrony and low radiation exposure in pediatric patients with CAVB.

      Graphical abstract

      Keywords

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