Key result
Left univentricular epicardial pacing significantly improved left ventricular ejection fraction from 33.48% to 60.18% in young children with dilated cardiomyopathy and left bundle branch block.
Why the study?
Heart failure management in young children is challenging, and the effect of left univentricular epicardial pacing on pediatric dilated cardiomyopathy with left bundle branch block required clarification.
Does left univentricular epicardial pacing improve cardiac function and reverse remodeling in young children with dilated cardiomyopathy and LBBB?
Observational (n=5)
No
Does left univentricular epicardial pacing improve cardiac function and reverse remodeling in young children with dilated cardiomyopathy and LBBB?
Absolute Event Rate: 60.18% vs 33.48%
p-value: p=0.006
Left univentricular epicardial pacing achieved hyper-responsiveness and significant reverse remodeling in young children with dilated cardiomyopathy and LBBB.
May support univentricular pacing for reverse remodeling in select pediatric DCM with LBBB; hypothesis-generating and requires prospective validation before practice change.
AIMS: The management of heart failure (HF) in young children is challenging. The present study aimed to clarify the effect of left univentricular epicardial pacing on dilated cardiomyopathy with left bundle branch block (LBBB) in children. METHODS AND RESULTS: A total of five cases (30.86 ± 16.39 months, three female) of children weighing 5.8-15 kg with dilated cardiomyopathy and LBBB were included in this study. LBBB in one child occurred after device closure of peri-membranous ventricular septal defects, and the remaining four were idiopathically discovered early after birth. Before implantation, all children suffered from refractory HF and cardiac dilatation; the left ventricular ejection fraction was 33.48 ± 5.84% with Ross Heart Failure Classification III-IV. Electrical and mechanical dyssynchrony were observed in all children with QRS duration >140 ms and prolonged septal-to-left posterior wall motion delay. Left univentricular epicardial pacing was successfully implanted via left axillary minithoracotomy in the five children. Sensed atrioventricular delays (83 ± 15 ms) were optimized by velocity time integral of aortic blood flow before discharge. During the follow-up period (10.8 ± 2.68 months), the dilated failing heart was reversed significantly in terms of decreased left ventricular dimension (55.62 ± 3.46 vs. 38.94 ± 3.69 mm, P = 0.005), while the left ventricular ejection fraction improved to 60.18 ± 8.78% (P = 0.006). CONCLUSIONS: In young children with low body weight, if HF is caused by or related to LBBB, left ventricular epicardial pacing still has an excellent effect.
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Sun et al. (2021) conducted an observational in Dilated cardiomyopathy with left bundle branch block (n=5). Left univentricular epicardial pacing vs. Baseline was evaluated on Left ventricular ejection fraction (LVEF) (p=0.006). Left univentricular epicardial pacing significantly improved left ventricular ejection fraction from 33.48% to 60.18% in young children with dilated cardiomyopathy and left bundle branch block.
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