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Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey
  1. Irene E van Geldorp1,2,
  2. Tammo Delhaas2,3,
  3. Roman A Gebauer4,
  4. Patrick Frias5,
  5. Maren Tomaske6,
  6. Mark K Friedberg7,
  7. Svjetlana Tisma-Dupanovic8,
  8. Jan Elders9,
  9. Andreas Früh10,
  10. Fulvio Gabbarini11,
  11. Petr Kubuš12,
  12. Viera Illikova13,
  13. Sabrina Tsao14,
  14. Andreas Christian Blank15,
  15. Anita Hiippala16,
  16. Thierry Sluysmans17,
  17. Peter Karpawich18,
  18. Sally-Ann Clur19,
  19. Xavier Ganame20,
  20. Kathryn K Collins21,
  21. Gisela Dann22,
  22. Jean-Benoît Thambo23,
  23. Conceição Trigo24,
  24. Bert Nagel25,
  25. John Papagiannis26,
  26. Annette Rackowitz27,
  27. Jan Marek28,
  28. Jan-Hendrik Nürnberg29,
  29. Ward Y Vanagt2,20,30,
  30. Frits W Prinzen30,
  31. Jan Janousek12,
  32. for the Working Group for Cardiac Dysrhythmias and Electrophysiology of the Association for European Paediatric Cardiology
  1. 1Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Pediatric Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
  5. 5Sibley Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, USA
  6. 6Paediatric Cardiology, University Children's Hospital, Zürich, Switzerland
  7. 7Devision of Cardiology, Hospital for Sick Children, Toronto, Canada
  8. 8Department of Cardiology, Children's Mercy Hospital, Kansas City, USA
  9. 9Department of Pediatric Cardiology, Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands
  10. 10Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
  11. 11Department of Pediatric Cardiology, Ospedale Infantile Regina Margherita, Turin, Italy
  12. 12Cardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic
  13. 13Department of Pediatric Cardiology, Children's Cardiac Center, Bratislava, Slovakia
  14. 14Department of Electrophysiology, Children's Memorial Hospital, Chicago, USA
  15. 15Department of Pediatric Cardiology, Wilhelmina Kinderziekenhuis, University Medical Center, Utrecht, The Netherlands
  16. 16Department of Pediatric Cardiology, Hospital for Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
  17. 17Department of Pediatric and Congenital Cardiology, Clinique Universitaire Saint-Luc, Brussels, Belgium
  18. 18Department of Cardiac Electrophysiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA
  19. 19Department of Pediatric Cardiology, Emma Kinderziekenhuis, Academisch Medisch Centrum, Amsterdam, The Netherlands
  20. 20Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
  21. 21Department of Pediatric Cardiology, Children's Hospital University of Colorado, Denver, USA
  22. 22Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany
  23. 23Department of Congenital Heart Disease, Hôpital Cardiologique du Haut-Lévéque, Bordeaux University, Bordeaux-Pessac, France
  24. 24Department of Pediatric Cardiology, Santa Marta Hospital, Lisbon, Portugal
  25. 25Department of Pediatric Cardiology, University Children's Hospital, Graz, Austria
  26. 26Department of Pediatric Cardiology, Mitera Children's Hospital, Maroussi, Greece
  27. 27Department of Pediatric Cardiology, Sophia Kinderziekenhuis, Erasmus University Medical Center, Rotterdam, The Netherlands
  28. 28Department of Cardiothoracics, Great Ormond Street Hospital, London, United Kingdom
  29. 29Department of Congenital Heart Disease and Pediatric Cardiology, Klinikum Links der Weser, Bremen, Germany
  30. 30Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Irene E van Geldorp, Cardiovascular Research Institute Maastricht, Department of Cardiology, Maastricht University Medical Center, PO Box 616, Maastricht NL-6200 MD, The Netherlands; i.vangeldorp{at}


Background Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function.

Objective In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated.

Methods Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics.

Results From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n=147), RV endocardium (RVendo, n=113) or LV epicardium (LVepi, n=37). LVFS was significantly affected by pacing site (p=0.001), and not by maternal autoantibody status (p=0.266). LVFS in LVepi (39±5%) was significantly higher than in RVendo (33±7%, p<0.001) and RVepi (35±8%, p=0.001; no significant difference between RV-paced groups, p=0.275). Subnormal LVFS (LVFS<28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS≥28%) in all LVepi-paced children (p=0.049). These results are supported by the findings for LVEF (n=122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥50% in 17/18 (94%) LVepi-paced patients.

Conclusion In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.

  • Pediatrics
  • pacing
  • pacing site
  • LV function
  • atrioventricular block
  • pacemakers
  • congenital heart disease
  • paediatric cardiology
  • cardiac function
  • imaging and diagnostics
  • paediatric electrophysiology
  • paediatric arrhythmias
  • Fallot's tetralogy
  • echocardiography-fetal
  • transposition of the great arteries
  • echocardiography-paediatrics
  • paediatric echocardiology
  • QT interval
  • paediatric interventional cardiology
  • interventional cardiology
  • radiofrequency ablation (RFA)
  • myocardial disease
  • haemodynamics
  • cardiac resynchronisation therapy

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  • Funding JJ was supported by the research project of University Hospital Motol MZOFNM2005.

  • Competing interests None.

  • Ethics approval Maastricht University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.