Pediatric cardiac resynchronization pacing therapy

Abstract

Purpose of review: Advances in pacemaker lead designs, permitting precise lead implantation at sites other than the ventricular apex, have provoked interest in the utilization of ventricular pacing beyond maintenance of heart rate. Select older adult patients with various cardiomyopathies may improve clinically following alternative site, biventricular and cardiac resynchronization pacing. This report reviews recent applications and directions of these pacing technologies to younger patients with congenital heart defects.

Recent findings: Acutely, following congenital heart surgery or chronically, studies now indicate that select younger patients may demonstrate physiologic benefits from pacing preselected single ventricular or combined right and left ventricular sites. This may prevent eventual paced myocardial deterioration as well as support and even reverse existing myocardial dysfunction, deferring the need for heart transplantation.

Summary: There are limited worldwide pediatric experiences, and, to date, no randomized multicenter studies. It is becoming more evident, however, that as these pacing techniques are used in younger patients, clinical improvements, comparable to older adult patients, even delaying heart transplant, may be anticipated. Since these newer techniques are more complicated and costly than simple pacemaker implantation, future directions will be for multi-institutional pediatric studies with clear definition of which pre-implant variables will define physiologic improvement.