Key result
Para-hisian RVP links to shorter LVAT versus midseptum pacing, mimicking sinus rhythm activation.
Why the study?
Right ventricular pacing may cause electromechanical dyssynchrony, but left ventricular endocardial activation sequence had primarily been mapped in adults.
Does right ventricular pacing at different sites alter left ventricular endocardial activation times and patterns compared to sinus rhythm in pediatric patients?
Observational (n=17)
No
Does right ventricular pacing at different sites alter left ventricular endocardial activation times and patterns compared to sinus rhythm in pediatric patients?
In pediatric patients, para-hisian pacing provides the shortest left ventricular activation time among right ventricular pacing sites, with an activation pattern similar to sinus rhythm.
Answers are grounded in this paper and cite their sources.
Para-hisian RV pacing may minimize LV dyssynchrony in children; hypothesis-generating and needs randomized confirmation before practice change.
Background Cardiac pacing from right ventricular (RV) sites may cause electromechanical ventricular dyssynchrony. Invasive and noninvasive mapping studies showed left ventricular (LV) activation sequence in adults. Aim of this study was to seek out the LV endocardial activation (LVEA) in pediatric patients who underwent RV pacing. Methods Single‐center, prospective study conducted on pediatric patients who underwent left sided catheter ablation of accessory pathways with the Carto Univu mapping system. After successful ablation procedures, LVEA was recorded by the ablation catheter during sinus rhythm (SR) and during para‐hisian (PHP), midseptum (MSP), and apical (RVAP) pacing. Results Seventeen patients, 13 males, aged 12 (10–15) years, registered LV activation maps and times (LVAT). SR showed significantly shorter LVAT than during pacing. LVAT of PHP was shorter than MSP, while there were not significant differences among PHP and MSP versus RVAP. In SR initial LV endocardial activation occurred in two midseptum sites, inferior‐posterior and superior‐anterior. During PHP, initial activation occurred at parahisian basal septum, rapidly followed by midseptum as in SR. During MSP and RVAP initial activation occurred at midseptum and apex, respectively. From all initial sites, the excitation spreads toward the base of the lateral LV free wall. A mild linear correlation was found between QRS duration and LVAT for MSP and for PHP. Conclusions In pediatric patients LVEA maps during RV pacing showed that the shortest LVAT was obtained with PHP. The LV activation pattern seemed similar in sinus rhythm, PHP and MSP, from midseptum to LV lateral base.
No takes yet. Share an insight, caveat, or question.
Silvetti et al. (2023) conducted an observational in Accessory pathways requiring left-sided catheter ablation (n=17). Right ventricular pacing (para-hisian, midseptum, and apical) vs. Sinus rhythm was evaluated on Left ventricular activation times (LVAT) and activation maps. Right ventricular pacing from the para-hisian site resulted in the shortest left ventricular activation times compared to midseptum pacing, with activation patterns similar to sinus rhythm.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: