Pacing in children and young adults with nonsurgical atrioventricular block: Comparison of single-rate ventricular and dual-chamber modes

Peter P. Karpawich, Burton L. Perry, Zia Q. Farooki, Sandra K. Clapp, William L. Jackson, Cynthia A. Cicalese, Edward W. Green

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

A prospective comparison of physiologic response to single-rate ventricular and dual-chamber atrioventricular pacing was conducted in 14 pediatric patients (age 1 to 24 years, median 14) with symptomatic nonsurgical second- or third-degree atrioventricular block. All patients were studied acutely during cardiac catheterization before and after 1 hour of both pacing modes. Following pacemaker implant, eight patients were reevaluated after 1 month of each mode with symptom questionnaire, resting ECG, resting echocardiogram, and Doppler cardiac output measurement at rest and at peak treadmill exercise. Cardiac outputs (mean ± standard error) increased acutely (n = 14) with both ventricular (32 ± 12%) and dual-chamber (39 ± 10%) pacing over intrinsic rhythm values (p < 0.01 in both). During chronic pacing (n = 8), symptoms were reported only with the ventricular mode. Dual-chamber synchronous pacing was associated with improved mean resting shortening fraction and cardiac output, slower mean resting sinus rate (89 ± 5 compared to 73 ± 4 bpm (p < 0.02), and a 23% increase in mean excerise cardiac output (4.2 ± 0.4 compared to 3.4 ± 0.3 L/min/m2) compared to single-rate ventricular pacing. Exercise-induced dysrhythmias occurred only with ventricular pacing. This study demonstrates that pediatric patients with nonsurgical atrioventricular block can compensate for loss of atrioventricular synchrony at rest but exhibit improved cardiac function with chronic dual-chamber atrioventricular compared to single-rate ventricular pacing.

Original languageEnglish
Pages (from-to)316-321
Number of pages6
JournalAmerican Heart Journal
Volume113
Issue number2 PART 1
DOIs
StatePublished - Feb 1987

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