What does this research mean for the field?

Rate responsive ventricular pacing (VVIR) does not improve physiological performance or exercise capacity in children with univentricular hearts following the Fontan procedure, despite successfully increasing heart rate during exercise. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 1, 1991Pacing and Clinical Electrophysiology

Failure of Rate Responsive Ventricular Pacing to Improve Physiological Performance in the Univentricular Heart

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Why the study?

Does rate responsive ventricular pacing (VVIR) improve physiological performance compared to fixed rate pacing (VVI) in children with symptomatic bradycardia following the Fontan procedure?

Population

6 postoperative children, ages 6–21 years, with symptomatic bradycardia requiring pacing therapy following…

Comparison

Single chamber, rate responsive ventricular… vs Fixed rate ventricular pacing programmed to…

Design

RCT, randomized fixed rate (VVI) and VVIR pacing modes

Authors

PKPeter P. KarpawichChildren's Hospital of Michigan SPStephen M. ParidonPediatric Cardiology WPWilliam W. PinskyPolessky State University

Discussion

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Implication

VVIR pacing fails to improve exercise capacity over VVI despite higher heart rates in post-Fontan children; challenges routine rate-responsive pacing in this population.

Structured PICO

Does rate responsive ventricular pacing (VVIR) improve physiological performance compared to fixed rate pacing (VVI) in children with symptomatic bradycardia following the Fontan procedure?

Population

6 postoperative children, ages 6–21 years (mean 13), with symptomatic bradycardia requiring pacing therapy following the Fontan procedure for univentricular hearts.

Intervention

Single chamber, rate responsive ventricular pacing (VVIR mode) with upper rate response at 150 ppm using implanted activity pulse generators (Medtronic Model 8403).

Comparator

Fixed rate ventricular pacing (VVI mode) programmed to identical age-appropriate low paced rates.

Outcome

Physiological performance during treadmill exercise testing including maximum work rate (watts), oxygen consumption (VO2), and ventilatory anaerobic threshold (VAT).surrogate

In children with univentricular hearts post-Fontan procedure, rate-responsive ventricular pacing improves chronotropic response but fails to improve exercise hemodynamics or physiological performance compared to fixed-rate pacing.

Cite This Study

Karpawich et al. (1991) studied this question.

synapsesocial.com/papers/6a15a94b9b87f33fc69fbe22 https://doi.org/10.1111/j.1540-8159.1991.tb02815.x

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Implication

VVIR pacing fails to improve exercise capacity over VVI despite higher heart rates in post-Fontan children; challenges routine rate-responsive pacing in this population.

Failure of Rate Responsive Ventricular Pacing to Improve Physiological Performance in the Univentricular Heart

Discussion

Member takes

Implication

Structured PICO

Cite This Study

Failure of Rate Responsive Ventricular Pacing to Improve Physiological Performance in the Univentricular Heart

Discussion

Member takes

Implication

Structured PICO

Cite This Study

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