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  • 1
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The advantages of atrial synchrony over asynchronous ventricular pacing remain unclear in the young, chronically right ventricular (RV) - paced patient. This is in contrast to the older patient with inherent diastolic dysfunction who has been shown to benefit from atrial synchrony with dual chamber (DDD,R/VDD), over single chamber rate response (VVI,R) ventricular pacing. The goal of this study was to noninvasively assess cardiac function in a group of young, RV-paced patients before and after establishment of atrial synchrony. Echocardiographic data were retrospectively analyzed from 10 patients with congenital or acquired complete AV block, who were VVI,R paced for 10.2 ± 2 years (mean age at study 19.2 ± 8.9 years), and were subsequently converted to DDD,R/VDD pacing (mean age at study 20.7 ± 9.5 years). Paired t-test analysis of left ventricular (LV) systolic and diastolic function during VVI,R versus DDD,R/VDD pacing did not result in any short-term difference in LV short axis fractional area of change or FAC (53%± 7.5% vs 56.8%± 8.7%) or mitral maximal velocity (E) normalized to mitral flow velocity time integral (VTI) (5.2/s ± 1.5 vs 4.4/s ± 1.5). A decrease in mitral flow E/A ratio was observed after short term DDD,R/VDD pacing (2.2 ± 0.5 vs 1.9 ± 0.3). Atrial synchronous dual chamber pacing in young patients with complete AV block does not lead to any appreciable early change in global LV function over single-site RV pacing. Therefore, early establishment of atrial synchrony in the young asymptomatic VVI,R-paced patient with normal intrinsic ventricular function may not be warranted. (PACE 2003; 26:1208–1211)
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Patient size and congenital heart defects complicate pacemaker therapy in children favoring an initial epicardial approach. Steroid-eluting (SE) epicardial (EPI) leads maintain stable, low pacing thresholds in the short-term when compared to the nonsteroid (NSE) epicardial (EPI) leads. The purpose of this study was to evaluate chronic, 10-year performance of SE leads in growing children compared with NSE EPI leads implanted during the same time interval. From 1990 to 2000, 35 patients (age 1 month to 18 year, median 3 years), 28 with and 7 without congenital heart disease (CHD) received 51 SE leads: 27 ventricular and 24 atrial. NSE leads were implanted in 27 patients (age 1–28 years, median 8 years), 24 with and 3 without CHD: 27 ventricular and 1 atrial. Pacing lead threshold, impedance, and energy were measured at implant and during a 10-year follow-up. Unpaired t-test showed that impedance remained stable for all leads with lower mean values for the SE (376 ± 55 vs 443 ± 109 Ω) (P = NS) . The mean energy requirement for SE leads at 10 years (1.2 ± 0.9 μJ) was significantly lower than for NSE (4.4 ± 5.5 μJ) (P 〈 0.05) . At 2.5-V output, chronic thresholds for SE leads did not significantly differ from implant values for atrial (0.08 vs 0.09 ms) or ventricular (0.08 vs 0.08 ms) sites. There were no differences in SE lead performances among patients with or without CHD. Fracture or dislodgement occurred in two SE (4%) and four NSE (14%) leads. SE outperform NSE EPI leads and show stable, chronic low thresholds over time in all growing children. (PACE 2003; 26[Pt. I]:1467–1471)
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of this study was to determine if single chamber rate responsive ventricular pacing (VVIR) predisposes growing children to develop pacemaker syndrome (PS), and if so, what are determining factors and/or clinically useful predictors. PS is a constellation of symptoms that result from the lack of consistent AV sequential filling due to atrial contraction against closed AV valves. PS has not been commonly reported in the young. Data from all patients with pacemakers with congenital complete atrioventricular block (CAVB) with normal anatomy, and those with congenital heart disease (CHD), and surgically acquired CAVB were reviewed. Inclusion criteria were normal ventricular function by cardiac ultrasound and 100% VVIR pacing. Of 89 patients with VVIR pacemaker implants, 33 met these criteria. Of these, 19 developed PS. For statistical analysis, chi-square and independent samples t-test was used with significance defined at P ≤ 0.05. No consistent association was found between cardiac anatomy, type of CAVB, or age at implant with development of PS. However, PS did correlate with duration of pacing (P = 0.02). The exercise stress test showed significant differences between 100% VVIR-paced patients with and without PS, in terms of work rate (P = 0.002) and measured oxygen consumption (P = 0.01). This study shows that PS appears to be a time related event in younger children with normal ventricular function who are 100% ventricular paced. Thus, this supports VVIR pacing as an adequate and cost-effective initial therapy for symptomatic bradycardia due to CAVB. (PACE 2004; 27:600–605)
    Type of Medium: Electronic Resource
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