What is the clinical evidence from this study?

Study design: Case Report. Population: Acquired complete atrioventricular heart block and pacemaker-mediated dilated cardiomyopathy (n=1). Intervention: Reduction of pacemaker upper tracking rate vs. Upper tracking rate of 210 bpm. Primary outcome: Biplane ejection fraction (BPEF).

What does this research mean for the field?

Reducing the upper tracking rate of a dual-chamber pacemaker can reverse pacemaker-mediated dilated cardiomyopathy in infants, significantly improving ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the manifestation and reversibility of cardiac dysfunction induced by physiologic high-rate dual-chamber pacing in an infant with complete atrioventricular block.

November 18, 2019HeartRhythm Case ReportsOpen Access

Reversible cardiac dysfunction associated with physiologic high-rate dual-chamber pacing in an infant with acquired complete atrioventricular heart block

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Key result

Reducing the upper tracking rate of a dual-chamber pacemaker from 210 to 160 beats per minute reversed pacemaker-mediated dilated cardiomyopathy in an infant, improving biplane ejection fraction from 37% to 56%.

Why the study?

Detrimental effects of pacing causing dilated cardiomyopathy are recognized in infants with complete atrioventricular block requiring pacemakers, where minimizing ventricular pacing frequency and cardiac resynchronization therapy promote reverse remodeling.

Does reducing the upper tracking rate in dual-chamber pacing improve pacemaker-mediated dilated cardiomyopathy in an infant with acquired CAVB?

Population

An infant with acquired complete atrioventricular block

Design

Case report

Authors

SRSteven L. RathgeberBritish Columbia Children's Hospital GSGabrielle E. SanataniRoyal Military Academy Sandhurst SSShubhayan SanataniElectrophysiology

Discussion

Member takes

Implication

May support upper-rate reduction in select infant cases; hypothesis-generating and requires prospective validation before practice change.

Key Points

To describe the manifestation and reversibility of cardiac dysfunction induced by physiologic high-rate dual-chamber pacing in an infant with complete atrioventricular block.
Evaluated a clinical case of an infant who underwent pacemaker implantation for acquired complete atrioventricular block.
Monitored changes in ventricular function and structural remodeling following pacing adjustments and cardiac resynchronization therapy.
High-rate dual-chamber ventricular pacing led to the development of dilated cardiomyopathy in the infant.
Interventions reducing ventricular pacing burden alongside cardiac resynchronization therapy prompted successful reverse remodeling and recovery of cardiac function.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does reducing the upper tracking rate in dual-chamber pacing improve pacemaker-mediated dilated cardiomyopathy in an infant with acquired CAVB?

Population

A newborn male twin with d-transposition of the great arteries with a small perimembranous ventricular septal defect who developed acquired complete atrioventricular block (CAVB) postoperatively (n=1).

Intervention

Reduction of the upper tracking rate of a dual-chamber pacemaker from 210 bpm to 160 bpm.

Outcome

Reversal of pacemaker-mediated dilated cardiomyopathy (improvement in left ventricular function and dimensions).surrogate

Main Result

Absolute Event Rate: 56% vs 37%

Reducing the upper tracking rate in dual-chamber pacing can reverse pacemaker-mediated dilated cardiomyopathy in infants with acquired complete atrioventricular block.

Limitations

Single case report
Use of beta-blocker (atenolol) could be a potential confounder, although remodeling continued after its discontinuation

Cite This Study

Rathgeber et al. (2019) conducted a case report in Acquired complete atrioventricular heart block and pacemaker-mediated dilated cardiomyopathy (n=1). Reduction of pacemaker upper tracking rate vs. Upper tracking rate of 210 bpm was evaluated on Biplane ejection fraction (BPEF). Reducing the upper tracking rate of a dual-chamber pacemaker from 210 to 160 beats per minute reversed pacemaker-mediated dilated cardiomyopathy in an infant, improving biplane ejection fraction from 37% to 56%.

synapsesocial.com/papers/6a15a9479b87f33fc69fbe10 https://doi.org/10.1016/j.hrcr.2019.11.001

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Implication

May support upper-rate reduction in select infant cases; hypothesis-generating and requires prospective validation before practice change.

Reversible cardiac dysfunction associated with physiologic high-rate dual-chamber pacing in an infant with acquired complete atrioventricular heart block

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Reversible cardiac dysfunction associated with physiologic high-rate dual-chamber pacing in an infant with acquired complete atrioventricular heart block

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider