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Open Access 01-05-2011

Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease

Authors: Irene E. van Geldorp, Ward Y. Vanagt, Frits W. Prinzen, Tammo Delhaas

Published in: Heart Failure Reviews | Issue 3/2011

Abstract

In children with congenital or acquired complete atrioventricular (AV) block, ventricular pacing is indicated to increase heart rate. Ventricular pacing is highly beneficial in these patients, but an important side effect is that it induces abnormal electrical activation patterns. Traditionally, ventricular pacemaker leads are positioned at the right ventricle (RV). The dyssynchronous pattern of ventricular activation due to RV pacing is associated with an acute and chronic impairment of left ventricular (LV) function, structural remodeling of the LV, and increased risk of heart failure. Since the degree of pacing-induced dyssynchrony varies between the different pacing sites, ‘optimal-site pacing’ should aim at the prevention of mechanical dyssynchrony. Especially in children, generally paced from a very early age and having a perspective of life-long pacing, the preservation of cardiac function during chronic ventricular pacing should take high priority. In the perspective of the (patho)physiology of ventricular pacing and the importance of the sequence of activation, this paper provides an overview of the current knowledge regarding possible alternative sites for chronic ventricular pacing. Furthermore, clinical implications and practical concerns of the various pacing sites are discussed. The review concludes with recommendations for optimal-site pacing in children.

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Title: Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease
Authors: Irene E. van Geldorp
Ward Y. Vanagt
Frits W. Prinzen
Tammo Delhaas
Publication date: 01-05-2011
Publisher: Springer US
Published in: Heart Failure Reviews / Issue 3/2011
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-010-9207-1

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