4.7 Article

Impact and Modifiers of Ventricular Pacing in Patients With Single Ventricle Circulation

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 80, Issue 9, Pages 902-914

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.05.053

Keywords

cardiac resynchronization therapy; cardiac transplant; congenital heart disease; electrical dyssynchrony; Fontan; Glenn; heart failure; pediatric; single ventricle

Funding

  1. Ministry of Health, Czech Republic

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This study aimed to quantify the risk of permanent ventricular pacing (PPMv) in patients with single ventricle (SV) and identify modifiable risk factors. The results showed that PPMv was associated with an increased risk of heart transplantation and death. Higher ventricular pacing percentage (Vp), higher QRS z-score, and nonapical ventricular lead position were all associated with a higher risk of adverse outcomes.
BACKGROUND Palliation of the single ventricle (SV) circulation is associated with a burden of lifelong complications. Previous studies have identified that the need for a permanent ventricular pacing system (PPMv) may be associated with additional adverse long-term outcomes. OBJECTIVES The goal of this study was to quantify the attributable risk of PPMv in patients with SV, and to identify modifiable risk factors. METHODS This international study was sponsored by the Pediatric and Congenital Electrophysiology Society. Centers contributed baseline and longitudinal data for functionally SV patients with PPMv. Enrollment was at implantation. Controls were matched 1:1 to PPMv subjects by ventricular morphology and sex, identified within center, and enrolled at matched age. Primary outcome was transplantation or death. RESULTS In total, 236 PPMv subjects and 213 matched controls were identified (22 centers, 9 countries). Median age at enrollment was 5.3 years (quartiles: 1.5-13.2 years), follow-up 6.9 years (3.4-11.6 years). Median percent ventricular pacing (Vp) was 90.8% (25th-75th percentile: 4.3%-100%) in the PPMv cohort. Across 213 matched pairs, multivariable HR for death/transplant associated with PPMv was 3.8 (95% CI 1.9-7.6; P < 0.001). Within the PPMv population, higher Vp (HR: 1.009 per %; P = 0.009), higher QRS z-score (HR: 1.19; P = 0.009) and nonapical lead position (HR: 2.17; P = 0.042) were all associated with death/transplantation. CONCLUSIONS PPMv in patients with SV is associated with increased risk of heart transplantation and death, despite controlling for increased associated morbidity of the PPMv cohort. Increased Vp, higher QRS z-score, and nonapical ventricular lead position are all associated with higher risk of adverse outcome and may be modifiable risk factors. (c) 2022 by the American College of Cardiology Foundation.

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