Background: Alternative right ventricular (RV) sites (RVAPS) have been proposed to prevent or reduce RV pacing-induced left-ventricular (LV) dysfunction. Nonfluoroscopic 3D electroanatomic mapping systems (EAM) have been developed to guide cardiac catheter navigation and reduce fluoroscopy during electrophysiological procedures or pacemaker implantations. Aim: The aim of the study was to compare the results of EAM-guided permanent pacemaker implantation aiming at RVAPS with conventional fluoroscopic-guided implantation in RV apex (RVA) in children and adolescents. Methods: A prospective, randomized analysis was performed on children/adolescents with complete atrioventricular block (CAVB) who underwent EAM-guided pacemaker and transvenous leads implantation into RVAPS (EAM-RVAPS) or conventional, fluoroscopic-guided implantation into RV apex (RVA). In EAM-RVAPS, a pacing map guided the implantation of ventricular leads in septal sites with narrower QRS. After implantation, LV contractility (ejection fraction [EF], Global Longitudinal Strain [GLS]) and synchrony were evaluated at 1–12 months. Results: Twenty-one pediatric patients with CAVB, with (six patients) or without structural heart diseases, aged 4–16 (median 10.5) years, were divided in two groups: EAM-RVAPS (11 patients, four dual-chamber/DDD, seven single-chamber/VVIR pacemakers) and RVA (10 patients, one DDD/nine VVIR). The two groups did not show significant differences for preoperative parameters. EAM-RVAPS showed: preserved LVEF and synchrony (not significantly different than RVA), significantly lower GLS and radiation doses/exposures, in spite more complex procedures, significantly longer procedure times and narrower paced QRS than RVA. Conclusions: EAM-guided procedures have been useful to reduce radiation exposure and to localize RVAPS with narrower paced QRS and lower GLS than RVA.

Electroanatomic mapping-guided localization of alternative right ventricular septal pacing sites in children / Silvetti, Massimo Stefano; Battipaglia, Irma; Pazzano, Vincenzo; Saputo, Fabio Anselmo; Ravà, Lucilla; Ammirati, Antonio; Calvieri, Camilla; Ciani, Michele; Drago, Fabrizio. - In: PACING AND CLINICAL ELECTROPHYSIOLOGY. - ISSN 0147-8389. - 41:9(2018), pp. 1204-1211. [10.1111/pace.13447]

Electroanatomic mapping-guided localization of alternative right ventricular septal pacing sites in children

Saputo, Fabio Anselmo;Calvieri, Camilla
Methodology
;
2018

Abstract

Background: Alternative right ventricular (RV) sites (RVAPS) have been proposed to prevent or reduce RV pacing-induced left-ventricular (LV) dysfunction. Nonfluoroscopic 3D electroanatomic mapping systems (EAM) have been developed to guide cardiac catheter navigation and reduce fluoroscopy during electrophysiological procedures or pacemaker implantations. Aim: The aim of the study was to compare the results of EAM-guided permanent pacemaker implantation aiming at RVAPS with conventional fluoroscopic-guided implantation in RV apex (RVA) in children and adolescents. Methods: A prospective, randomized analysis was performed on children/adolescents with complete atrioventricular block (CAVB) who underwent EAM-guided pacemaker and transvenous leads implantation into RVAPS (EAM-RVAPS) or conventional, fluoroscopic-guided implantation into RV apex (RVA). In EAM-RVAPS, a pacing map guided the implantation of ventricular leads in septal sites with narrower QRS. After implantation, LV contractility (ejection fraction [EF], Global Longitudinal Strain [GLS]) and synchrony were evaluated at 1–12 months. Results: Twenty-one pediatric patients with CAVB, with (six patients) or without structural heart diseases, aged 4–16 (median 10.5) years, were divided in two groups: EAM-RVAPS (11 patients, four dual-chamber/DDD, seven single-chamber/VVIR pacemakers) and RVA (10 patients, one DDD/nine VVIR). The two groups did not show significant differences for preoperative parameters. EAM-RVAPS showed: preserved LVEF and synchrony (not significantly different than RVA), significantly lower GLS and radiation doses/exposures, in spite more complex procedures, significantly longer procedure times and narrower paced QRS than RVA. Conclusions: EAM-guided procedures have been useful to reduce radiation exposure and to localize RVAPS with narrower paced QRS and lower GLS than RVA.
2018
alternative pacing sites; cardiac pacing; nonfluoroscopic mapping system; pediatric age; radiation exposure; atrioventricular block; cardiac pacing, artificial; child; child, preschool; female; fluoroscopy; heart ventricles; humans; male; prospective studies; treatment outcome; ventricular dysfunction, left; pacemaker, artificial; cardiology and cardiovascular medicine
01 Pubblicazione su rivista::01l Trial clinico
Electroanatomic mapping-guided localization of alternative right ventricular septal pacing sites in children / Silvetti, Massimo Stefano; Battipaglia, Irma; Pazzano, Vincenzo; Saputo, Fabio Anselmo; Ravà, Lucilla; Ammirati, Antonio; Calvieri, Camilla; Ciani, Michele; Drago, Fabrizio. - In: PACING AND CLINICAL ELECTROPHYSIOLOGY. - ISSN 0147-8389. - 41:9(2018), pp. 1204-1211. [10.1111/pace.13447]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1266546
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