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Single lead VDD pacing in children with complete heart block. 1998

A Bullock, and J Finley, and G Sharratt, and D Ross
Department of Cardiology, Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia.

OBJECTIVE To evaluate clinically transvenous single lead VDD pacing in children with complete heart block. METHODS Case series. METHODS Tertiary care unit of a pediatric teaching hospital. METHODS Consecutive sample of children with complete heart block requiring pacing and meeting the criteria for VDD pacing. METHODS VDD single lead pacing systems (Thera VDD 8948 generator, Capsure VDD 5032 single pass lead) were implanted in nine children (mean age 10.7 years, 95% CI 8.9 to 12.3). All patients were reviewed six weeks and six months post-implantation with clinical review, detailed pacemaker interrogation, optimal device programming, treadmill exercise testing, 24 h Holter monitoring and echocardiography. RESULTS Mean procedure time was 62.5 mins (CI 52 to 73), mean fluoroscopy time 3.8 mins (CI 2.4 to 5.1) and mean P wave sensing amplitude 2.75 mV (CI 2.5 to 3), without significant decrease during Valsalva manoeuvre (mean 2.4 mV, CI 2.2 to 2.8). Low pacing thresholds of mean amplitude 0.39 V (CI 0.38 to 0.4) were established at pulse width 0.5 ms. Two patients required early revision--one lead dislodged and one patient had a loose set screw. Follow-up showed satisfactory pacemaker function, and mean percentage atrioventricular (AV) synchronous pacing 96.8% (CI 93 to 99) at six weeks and 97% (CI 95 to 99) at six months. P wave sensing failures were less than 1%. AV synchronous pacing was maintained for more than 99% of the period of treadmill exercise testing. There was a significant mean increase in cardiac output of 24% (CI 8 to 40, P < 0.05) at rest in VDD mode compared with VVIR mode. CONCLUSIONS Single lead VDD pacing is an effective and reliable method of 'physiological' rate responsive AV synchronous pacing in children with complete heart block and should be considered a viable alternative to dual lead pacing systems.

UI MeSH Term Description Entries
D002304 Cardiac Pacing, Artificial Regulation of the rate of contraction of the heart muscles by an artificial pacemaker. Pacing, Cardiac, Artificial,Artificial Cardiac Pacing,Artificial Cardiac Pacings,Cardiac Pacings, Artificial,Pacing, Artificial Cardiac,Pacings, Artificial Cardiac
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D004452 Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Echocardiography, Contrast,Echocardiography, Cross-Sectional,Echocardiography, M-Mode,Echocardiography, Transthoracic,Echocardiography, Two-Dimensional,Transthoracic Echocardiography,2-D Echocardiography,2D Echocardiography,Contrast Echocardiography,Cross-Sectional Echocardiography,Echocardiography, 2-D,Echocardiography, 2D,M-Mode Echocardiography,Two-Dimensional Echocardiography,2 D Echocardiography,Cross Sectional Echocardiography,Echocardiography, 2 D,Echocardiography, Cross Sectional,Echocardiography, M Mode,Echocardiography, Two Dimensional,M Mode Echocardiography,Two Dimensional Echocardiography
D005080 Exercise Test Controlled physical activity which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. Arm Ergometry Test,Bicycle Ergometry Test,Cardiopulmonary Exercise Testing,Exercise Testing,Step Test,Stress Test,Treadmill Test,Cardiopulmonary Exercise Test,EuroFit Tests,Eurofit Test Battery,European Fitness Testing Battery,Fitness Testing,Physical Fitness Testing,Arm Ergometry Tests,Bicycle Ergometry Tests,Cardiopulmonary Exercise Tests,Ergometry Test, Arm,Ergometry Test, Bicycle,Ergometry Tests, Arm,Ergometry Tests, Bicycle,EuroFit Test,Eurofit Test Batteries,Exercise Test, Cardiopulmonary,Exercise Testing, Cardiopulmonary,Exercise Tests,Exercise Tests, Cardiopulmonary,Fitness Testing, Physical,Fitness Testings,Step Tests,Stress Tests,Test Battery, Eurofit,Test, Arm Ergometry,Test, Bicycle Ergometry,Test, Cardiopulmonary Exercise,Test, EuroFit,Test, Exercise,Test, Step,Test, Stress,Test, Treadmill,Testing, Cardiopulmonary Exercise,Testing, Exercise,Testing, Fitness,Testing, Physical Fitness,Tests, Arm Ergometry,Tests, Bicycle Ergometry,Tests, Cardiopulmonary Exercise,Tests, EuroFit,Tests, Exercise,Tests, Step,Tests, Stress,Tests, Treadmill,Treadmill Tests
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006327 Heart Block Impaired conduction of cardiac impulse that can occur anywhere along the conduction pathway, such as between the SINOATRIAL NODE and the right atrium (SA block) or between atria and ventricles (AV block). Heart blocks can be classified by the duration, frequency, or completeness of conduction block. Reversibility depends on the degree of structural or functional defects. Auriculo-Ventricular Dissociation,A-V Dissociation,Atrioventricular Dissociation,A V Dissociation,A-V Dissociations,Atrioventricular Dissociations,Auriculo Ventricular Dissociation,Auriculo-Ventricular Dissociations,Block, Heart,Blocks, Heart,Dissociation, A-V,Dissociation, Atrioventricular,Dissociation, Auriculo-Ventricular,Dissociations, A-V,Dissociations, Atrioventricular,Dissociations, Auriculo-Ventricular,Heart Blocks
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D012720 Severity of Illness Index Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder. Illness Index Severities,Illness Index Severity
D015716 Electrocardiography, Ambulatory Method in which prolonged electrocardiographic recordings are made on a portable tape recorder (Holter-type system) or solid-state device ("real-time" system), while the patient undergoes normal daily activities. It is useful in the diagnosis and management of intermittent cardiac arrhythmias and transient myocardial ischemia. Ambulatory Electrocardiography,Electrocardiography, Dynamic,Electrocardiography, Holter,Holter ECG,Holter EKG,Holter Monitoring,Monitoring, Ambulatory Electrocardiographic,Monitoring, Holter,Ambulatory Electrocardiography Monitoring,Dynamic Electrocardiography,Electrocardiography Monitoring, Ambulatory,Holter Electrocardiography,Ambulatory Electrocardiographic Monitoring,ECG, Holter,ECGs, Holter,EKG, Holter,EKGs, Holter,Electrocardiographic Monitoring, Ambulatory,Holter ECGs,Holter EKGs,Monitoring, Ambulatory Electrocardiography

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