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Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair

OBJECTIVE: Pacing in a univentricular circulation has been associated with worsened outcomes. We investigated the long‐term outcomes of pacing in children with a univentricular circulation compared to a complex biventricular circulation. We also identified predictors of adverse outcomes. METHODS: A...

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Autores principales: Spentzou, Georgia, Taylor, Luke, Zhang, Yiyan, D'Udekem, Yves, Zannino, Diana, Davis, Andrew, Pflaumer, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068957/
https://www.ncbi.nlm.nih.gov/pubmed/37021029
http://dx.doi.org/10.1002/joa3.12832
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author Spentzou, Georgia
Taylor, Luke
Zhang, Yiyan
D'Udekem, Yves
Zannino, Diana
Davis, Andrew
Pflaumer, Andreas
author_facet Spentzou, Georgia
Taylor, Luke
Zhang, Yiyan
D'Udekem, Yves
Zannino, Diana
Davis, Andrew
Pflaumer, Andreas
author_sort Spentzou, Georgia
collection PubMed
description OBJECTIVE: Pacing in a univentricular circulation has been associated with worsened outcomes. We investigated the long‐term outcomes of pacing in children with a univentricular circulation compared to a complex biventricular circulation. We also identified predictors of adverse outcomes. METHODS: A retrospective study of all children with major congenital heart disease who underwent pacemaker implantation under the age of 18 years between November 1994 and October 2017. RESULTS: Eighty‐nine patients were included; 19 with a univentricular and 70 with a complex biventricular circulation. A total of 96% of pacemaker systems were epicardial. Median follow up was 8.3 years. The incidence of adverse outcome was similar between the two groups. Five (5.6%) patients died and two (2.2%) underwent heart transplantation. Most adverse events occurred within the first 8 years after pacemaker implantation. Univariate analysis identified five predictors of adverse outcomes in the patients in the biventricular but none in the univentricular group. The predictors of adverse outcome in the biventricular circulation were a right morphologic ventricle as the systemic ventricle, age at first congenital heart disease (CHD) operation, number of CHD operations, and female gender. The nonapical lead position was associated with a much higher risk of an adverse outcome. CONCLUSIONS: Children with a pacemaker and a complex biventricular circulation have similar survival to the ones with a pacemaker and a univentricular circulation. The only modifiable predictor was the epicardial lead position on the paced ventricle, emphasizing the importance of apical placement of the ventricular lead.
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spelling pubmed-100689572023-04-04 Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair Spentzou, Georgia Taylor, Luke Zhang, Yiyan D'Udekem, Yves Zannino, Diana Davis, Andrew Pflaumer, Andreas J Arrhythm Original Articles OBJECTIVE: Pacing in a univentricular circulation has been associated with worsened outcomes. We investigated the long‐term outcomes of pacing in children with a univentricular circulation compared to a complex biventricular circulation. We also identified predictors of adverse outcomes. METHODS: A retrospective study of all children with major congenital heart disease who underwent pacemaker implantation under the age of 18 years between November 1994 and October 2017. RESULTS: Eighty‐nine patients were included; 19 with a univentricular and 70 with a complex biventricular circulation. A total of 96% of pacemaker systems were epicardial. Median follow up was 8.3 years. The incidence of adverse outcome was similar between the two groups. Five (5.6%) patients died and two (2.2%) underwent heart transplantation. Most adverse events occurred within the first 8 years after pacemaker implantation. Univariate analysis identified five predictors of adverse outcomes in the patients in the biventricular but none in the univentricular group. The predictors of adverse outcome in the biventricular circulation were a right morphologic ventricle as the systemic ventricle, age at first congenital heart disease (CHD) operation, number of CHD operations, and female gender. The nonapical lead position was associated with a much higher risk of an adverse outcome. CONCLUSIONS: Children with a pacemaker and a complex biventricular circulation have similar survival to the ones with a pacemaker and a univentricular circulation. The only modifiable predictor was the epicardial lead position on the paced ventricle, emphasizing the importance of apical placement of the ventricular lead. John Wiley and Sons Inc. 2023-02-12 /pmc/articles/PMC10068957/ /pubmed/37021029 http://dx.doi.org/10.1002/joa3.12832 Text en © 2023 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Spentzou, Georgia
Taylor, Luke
Zhang, Yiyan
D'Udekem, Yves
Zannino, Diana
Davis, Andrew
Pflaumer, Andreas
Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title_full Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title_fullStr Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title_full_unstemmed Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title_short Long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
title_sort long‐term outcomes of pacemaker implantation in children with univentricular versus complex biventricular surgical repair
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068957/
https://www.ncbi.nlm.nih.gov/pubmed/37021029
http://dx.doi.org/10.1002/joa3.12832
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