What question did this study set out to answer?

To evaluate the pathophysiological effects of chronic right ventricular pacing on cardiac contractility and remodeling, and to assess the benefits of selective pacing sites in children.

May 25, 2004Pacing and Clinical Electrophysiology

Chronic Right Ventricular Pacing and Cardiac Performance:

Q: What is the clinical evidence from this study?

Study design: Review. Population: Pacemaker therapy in children. Intervention: Selective site pacing (right ventricular septal, outflow, or bundle of His) vs. Right ventricular apical pacing.

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Key result

Selective site pacing in children shows promise in preventing adverse histological remodeling and deterioration of systemic ventricular contractility caused by right ventricular apical pacing.

Why the study?

Does selective site pacing prevent adverse remodeling and improve contractility compared to right ventricular apical pacing in children requiring pacemakers?

Population

Children with and without structural congenital heart defects requiring pacemaker therapy

Comparison

Selective site pacing vs Right ventricular apical or free-wall pacing

Design

Review

Authors

PKPeter P. KarpawichChildren's Hospital of Michigan

Discussion

Member takes

Implication

May support selective site pacing to mitigate remodeling in children; leaves open need for randomized confirmation.

Key Points

To evaluate the pathophysiological effects of chronic right ventricular pacing on cardiac contractility and remodeling, and to assess the benefits of selective pacing sites in children.
Narrative review synthesizing historical and modern literature on pacemaker therapy in pediatric cohorts with and without structural congenital heart defects.
Comparative analysis of impulse conduction, histological alterations, and ventricular performance between traditional apical pacing and alternative sites, including septal, outflow, and bundle of His pacing.
Chronic right ventricular apical and free-wall pacing causes electrical dyssynchrony and adverse cellular remodeling, progressively impairing left ventricular systolic and diastolic function.
Selective site pacing at the septum, outflow tract, or bundle of His provides physiological impulse propagation and shows promise in preventing contractile deterioration in pediatric patients.

Structured PICO

Does selective site pacing prevent adverse remodeling and improve contractility compared to right ventricular apical pacing in children requiring pacemakers?

Population

Children with and without structural congenital heart defects requiring pacemaker therapy

Intervention

Selective site pacing (right ventricular septal, outflow, or bundle of His pacing)

Comparator

Right ventricular apical or free-wall pacing

Outcome

Prevention of adverse histological remodeling and deterioration of systemic ventricular contractilitysurrogate

Selective site pacing in children may prevent the adverse histological remodeling and contractile dysfunction associated with traditional right ventricular apical pacing.

Limitations

Limited clinical pediatric studies evaluating precise site-specific lead locations
Limited clinical pediatric studies that evaluate precise site-specific lead locations

Cite This Study

Peter P. Karpawich (2004) conducted a review in Pacemaker therapy in children. Selective site pacing (right ventricular septal, outflow, or bundle of His) vs. Right ventricular apical pacing was evaluated. Selective site pacing in children shows promise in preventing adverse histological remodeling and deterioration of systemic ventricular contractility caused by right ventricular apical pacing.

synapsesocial.com/papers/6a1c59ef4ebd09f3dfa9bd1f https://doi.org/10.1111/j.1540-8159.2004.00545.x

Topics

Congenital heart disease adults

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Chronic Right Ventricular Pacing and Cardiac Performance:

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Chronic Right Ventricular Pacing and Cardiac Performance:

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider