Progressive QRS Duration and Ventricular Dysfunction in Pediatric Patients with Chronic Ventricular Pacing
- PDF / 1,183,531 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 52 Downloads / 205 Views
ORIGINAL ARTICLE
Progressive QRS Duration and Ventricular Dysfunction in Pediatric Patients with Chronic Ventricular Pacing Richard J. Czosek1,2 · Zhiqian Gao1 · Jeffrey B. Anderson1,2 · Timothy K. Knilans1,2 · Nicholas J. Ollberding2,3 · David S. Spar1,2 Received: 21 September 2020 / Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Pacemakers are a mainstay of therapy for patients with congenital and acquired heart block, but ventricular pacing is related to ventricular dysfunction. We sought to evaluate patient and device characteristics associated with ventricular dysfunction in pediatric patients with chronic ventricular pacing. This was a retrospective cohort of pediatric patients with heart block and chronic ventricular pacing. Patient, ECG, and device characteristics were analyzed to determine factors associated with ventricular dysfunction. Longitudinal ECG and echocardiogram parameters were obtained to track changes in QRS and systemic ventricular systolic function over time. In total, 82 patients were included (median age at implant 0.81 years). Over a follow-up time of 6.1 years, 18% developed ventricular dysfunction. Patients with dysfunction had greater current QRS duration (p = 0.002) compared to those with preserved function with a similar time from device implantation. There was no difference between lead location or age at device implantation. QRS duration increased with time from implant and the resultant ΔQRS was associated with ventricular dysfunction (p = 0.01). QRS duration >162 ms was associated with a 5.8 (2–9)-fold increased risk for dysfunction. Transvenous leads were associated with longer QRS duration with no difference compared to epicardial leads in development of ventricular dysfunction. This study demonstrated that the absolute paced QRS duration and Δpaced QRS were association with long-term ventricular dysfunction independent of how long a given patient was paced. Patients in high-risk categories may benefit from close echocardiographic monitoring. Whether permissive junctional rhythm or His bundle/biventricular pacing decreases the rate of dysfunction needs further study. Keywords Pacemaker · Ventricular dysfunction · Pediatrics · Dyssynchrony · Heart failure · Heart block Abbreviations CHB Congenital heart block CHD Congenital heart disease LBBB Left bundle branch block PCM Pacemaker LV Left ventricular
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00246-020-02504-x) contains supplementary material, which is available to authorized users. * Richard J. Czosek [email protected] 1
The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA
2
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
3
Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
RV Right ventricular BIV Biventricular
Backg
Data Loading...
