The development of pacing induced ventricular dysfunction is influenced by the underlying structural heart defect in children with congenital heart disease

Seshadri Balaji, Narayanswami Sreeram

Research output: Contribution to journalArticle

Abstract

Background: Right ventricular pacing can cause pacing-induced ventricular dysfunction (PIVD) correctable with biventricular pacing (BiVP). Factors associated with PIVD are poorly understood. Methods: We reviewed children receiving epicardial dual-chamber pacemakers for complete heart block (CHB) after congenital heart disease (CHD) surgery. PIVD was defined as% fractional shortening <15% improving after BiVP. Results: Between 2005 and 2014, 47 children <2. years developed CHB after CHD surgery. All had biventricular hearts and underwent epicardial dual chamber pacemaker implantation. Nine of the 47 (19%) developed PIVD. PIVD occurred in 0/10 with ventricular septal defect (VSD), 0/6 with tetralogy of Fallot, 2/6 with double outlet right ventricle, 2/6 with transposition and VSD, 3/9 with atrioventricular canal defect, 1/2 with mitral valve replacement; 1/3 with congenitally corrected TGA repair; and 0/3 with atrioventricular canal plus tetralogy of Fallot and 0/1 with subaortic membrane. QRS duration (QRSD) was 84-170 (median 135. ms) in the non PIVD group and 100-168 (median 124) ms in the PIVD group. Percentage fractional shortening (%FS) while paced was 16-46, median 30% in the non-PIVD group and 6-15 (median 11%) in the PIVD group.%FS post upgrade to BiVP (with an epicardial LV lead) in the 9 patients with PIVD was 23-33 (median 29%). Conclusions: PIVD occurred in certain CHD but not others. Prolonged QRSD was not associated with PIVD. The predilection for RV pacing to result in PIVD in certain types of CHD needs further study.

Original languageEnglish (US)
JournalIndian Heart Journal
DOIs
StateAccepted/In press - Jul 22 2016

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Ventricular Dysfunction
Heart Diseases
Cardiac Resynchronization Therapy
Tetralogy of Fallot
Ventricular Heart Septal Defects
Thoracic Surgery
Double Outlet Right Ventricle
Mitral Valve

Keywords

  • Children
  • Complete heart block
  • Congenital heart disease
  • Pacemaker
  • Pacing induced cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f37ba949aabb4a3db812e820f780c829,
title = "The development of pacing induced ventricular dysfunction is influenced by the underlying structural heart defect in children with congenital heart disease",
abstract = "Background: Right ventricular pacing can cause pacing-induced ventricular dysfunction (PIVD) correctable with biventricular pacing (BiVP). Factors associated with PIVD are poorly understood. Methods: We reviewed children receiving epicardial dual-chamber pacemakers for complete heart block (CHB) after congenital heart disease (CHD) surgery. PIVD was defined as{\%} fractional shortening <15{\%} improving after BiVP. Results: Between 2005 and 2014, 47 children <2. years developed CHB after CHD surgery. All had biventricular hearts and underwent epicardial dual chamber pacemaker implantation. Nine of the 47 (19{\%}) developed PIVD. PIVD occurred in 0/10 with ventricular septal defect (VSD), 0/6 with tetralogy of Fallot, 2/6 with double outlet right ventricle, 2/6 with transposition and VSD, 3/9 with atrioventricular canal defect, 1/2 with mitral valve replacement; 1/3 with congenitally corrected TGA repair; and 0/3 with atrioventricular canal plus tetralogy of Fallot and 0/1 with subaortic membrane. QRS duration (QRSD) was 84-170 (median 135. ms) in the non PIVD group and 100-168 (median 124) ms in the PIVD group. Percentage fractional shortening ({\%}FS) while paced was 16-46, median 30{\%} in the non-PIVD group and 6-15 (median 11{\%}) in the PIVD group.{\%}FS post upgrade to BiVP (with an epicardial LV lead) in the 9 patients with PIVD was 23-33 (median 29{\%}). Conclusions: PIVD occurred in certain CHD but not others. Prolonged QRSD was not associated with PIVD. The predilection for RV pacing to result in PIVD in certain types of CHD needs further study.",
keywords = "Children, Complete heart block, Congenital heart disease, Pacemaker, Pacing induced cardiomyopathy",
author = "Seshadri Balaji and Narayanswami Sreeram",
year = "2016",
month = "7",
day = "22",
doi = "10.1016/j.ihj.2016.11.325",
language = "English (US)",
journal = "Indian Heart Journal",
issn = "0019-4832",
publisher = "Cardiology Society of India",

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T1 - The development of pacing induced ventricular dysfunction is influenced by the underlying structural heart defect in children with congenital heart disease

AU - Balaji, Seshadri

AU - Sreeram, Narayanswami

PY - 2016/7/22

Y1 - 2016/7/22

N2 - Background: Right ventricular pacing can cause pacing-induced ventricular dysfunction (PIVD) correctable with biventricular pacing (BiVP). Factors associated with PIVD are poorly understood. Methods: We reviewed children receiving epicardial dual-chamber pacemakers for complete heart block (CHB) after congenital heart disease (CHD) surgery. PIVD was defined as% fractional shortening <15% improving after BiVP. Results: Between 2005 and 2014, 47 children <2. years developed CHB after CHD surgery. All had biventricular hearts and underwent epicardial dual chamber pacemaker implantation. Nine of the 47 (19%) developed PIVD. PIVD occurred in 0/10 with ventricular septal defect (VSD), 0/6 with tetralogy of Fallot, 2/6 with double outlet right ventricle, 2/6 with transposition and VSD, 3/9 with atrioventricular canal defect, 1/2 with mitral valve replacement; 1/3 with congenitally corrected TGA repair; and 0/3 with atrioventricular canal plus tetralogy of Fallot and 0/1 with subaortic membrane. QRS duration (QRSD) was 84-170 (median 135. ms) in the non PIVD group and 100-168 (median 124) ms in the PIVD group. Percentage fractional shortening (%FS) while paced was 16-46, median 30% in the non-PIVD group and 6-15 (median 11%) in the PIVD group.%FS post upgrade to BiVP (with an epicardial LV lead) in the 9 patients with PIVD was 23-33 (median 29%). Conclusions: PIVD occurred in certain CHD but not others. Prolonged QRSD was not associated with PIVD. The predilection for RV pacing to result in PIVD in certain types of CHD needs further study.

AB - Background: Right ventricular pacing can cause pacing-induced ventricular dysfunction (PIVD) correctable with biventricular pacing (BiVP). Factors associated with PIVD are poorly understood. Methods: We reviewed children receiving epicardial dual-chamber pacemakers for complete heart block (CHB) after congenital heart disease (CHD) surgery. PIVD was defined as% fractional shortening <15% improving after BiVP. Results: Between 2005 and 2014, 47 children <2. years developed CHB after CHD surgery. All had biventricular hearts and underwent epicardial dual chamber pacemaker implantation. Nine of the 47 (19%) developed PIVD. PIVD occurred in 0/10 with ventricular septal defect (VSD), 0/6 with tetralogy of Fallot, 2/6 with double outlet right ventricle, 2/6 with transposition and VSD, 3/9 with atrioventricular canal defect, 1/2 with mitral valve replacement; 1/3 with congenitally corrected TGA repair; and 0/3 with atrioventricular canal plus tetralogy of Fallot and 0/1 with subaortic membrane. QRS duration (QRSD) was 84-170 (median 135. ms) in the non PIVD group and 100-168 (median 124) ms in the PIVD group. Percentage fractional shortening (%FS) while paced was 16-46, median 30% in the non-PIVD group and 6-15 (median 11%) in the PIVD group.%FS post upgrade to BiVP (with an epicardial LV lead) in the 9 patients with PIVD was 23-33 (median 29%). Conclusions: PIVD occurred in certain CHD but not others. Prolonged QRSD was not associated with PIVD. The predilection for RV pacing to result in PIVD in certain types of CHD needs further study.

KW - Children

KW - Complete heart block

KW - Congenital heart disease

KW - Pacemaker

KW - Pacing induced cardiomyopathy

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