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

Henry Chubb¹, Anica Bulic², Douglas Mah³, Jeremy P Moore⁴, Jan Janousek⁵, Jennifer Fumanelli⁶, S Yukiko Asaki⁷, Andreas Pflaumer⁸, Allison C Hill⁹, Carolina Escudero¹⁰, Sit Yee Kwok¹¹, Jasveer Mangat¹², Luis A Ochoa Nunez¹³, Seshadri Balaji¹⁴, Eric Rosenthal¹⁵, William Regan¹⁵, Michaela Horndasch¹⁶, Hiroko Asakai¹⁷, Ronn Tanel¹⁸, Richard J Czosek¹⁹, Ming-Lon Young²⁰, David J Bradley²¹, Thomas Paul²², Peter Fischbach²³, Lindsey Malloy-Walton²⁴, Doff B McElhinney²⁵, Anne M Dubin²⁶

Affiliations

¹ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA. Electronic address: mhchubb@stanford.edu.
² Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
³ Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California, USA.
⁵ Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
⁶ Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; Pediatric Cardiology Unit, Department of Women's and Child's Health, University of Padova, Padova, Italy.
⁷ Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
⁸ The Royal Children's Hospital, MCRI and University of Melbourne, Melbourne, Victoria, Australia.
⁹ Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹⁰ Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹¹ Cardiology Centre, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.
¹² Paediatric Cardiology, Great Ormond Street, London, United Kingdom.
¹³ University of Iowa Healthcare, Iowa City, Iowa, USA.
¹⁴ Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA.
¹⁵ Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom.
¹⁶ Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
¹⁷ Department of Paediatrics, University of Tokyo Hospital, Tokyo, Japan.
¹⁸ Division of Pediatric Cardiology, Department of Pediatrics, UCSF School of Medicine, San Francisco, California, USA.
¹⁹ The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.
²⁰ Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.
²¹ University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan, USA.
²² Department of Pediatric Cardiology, Georg-August-University Medical Center, Göttingen, Germany.
²³ Sibley Heart Center, Atlanta, Georgia, USA.
²⁴ Children's Mercy Hospital, University of Missouri, Kansas City, Missouri, USA.
²⁵ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.
²⁶ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA.

PMID: 36007989
DOI: 10.1016/j.jacc.2022.05.053

Free article

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

Henry Chubb et al. J Am Coll Cardiol. 2022.

Free article

. 2022 Aug 30;80(9):902-914.

doi: 10.1016/j.jacc.2022.05.053.

Authors

Affiliations

¹ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA. Electronic address: mhchubb@stanford.edu.
² Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
³ Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California, USA.
⁵ Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
⁶ Children's Heart Centre, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; Pediatric Cardiology Unit, Department of Women's and Child's Health, University of Padova, Padova, Italy.
⁷ Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
⁸ The Royal Children's Hospital, MCRI and University of Melbourne, Melbourne, Victoria, Australia.
⁹ Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹⁰ Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹¹ Cardiology Centre, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.
¹² Paediatric Cardiology, Great Ormond Street, London, United Kingdom.
¹³ University of Iowa Healthcare, Iowa City, Iowa, USA.
¹⁴ Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA.
¹⁵ Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom.
¹⁶ Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
¹⁷ Department of Paediatrics, University of Tokyo Hospital, Tokyo, Japan.
¹⁸ Division of Pediatric Cardiology, Department of Pediatrics, UCSF School of Medicine, San Francisco, California, USA.
¹⁹ The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.
²⁰ Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.
²¹ University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan, USA.
²² Department of Pediatric Cardiology, Georg-August-University Medical Center, Göttingen, Germany.
²³ Sibley Heart Center, Atlanta, Georgia, USA.
²⁴ Children's Mercy Hospital, University of Missouri, Kansas City, Missouri, USA.
²⁵ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.
²⁶ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA.

PMID: 36007989
DOI: 10.1016/j.jacc.2022.05.053

Abstract

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 (PPM_v) may be associated with additional adverse long-term outcomes.

Objectives: The goal of this study was to quantify the attributable risk of PPM_v 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 PPM_v. Enrollment was at implantation. Controls were matched 1:1 to PPM_v subjects by ventricular morphology and sex, identified within center, and enrolled at matched age. Primary outcome was transplantation or death.

Results: In total, 236 PPM_v 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 PPM_v cohort. Across 213 matched pairs, multivariable HR for death/transplant associated with PPM_v was 3.8 (95% CI 1.9-7.6; P < 0.001). Within the PPM_v 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: PPM_v in patients with SV is associated with increased risk of heart transplantation and death, despite controlling for increased associated morbidity of the PPM_v 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.

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

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Drs Janousek and Fumanelli were supported by the Ministry of Health, Czech Republic: conceptual development of research organization, Motol University Hospital, Prague, Czech Republic. Dr Balaji has been a medical advisor/consultant to “yoR labs” (stock options). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Ventricular Pacing in Single Ventricle Circulation: Making the Best of a Difficult Situation.
Idriss SF, Weiland MD. Idriss SF, et al. J Am Coll Cardiol. 2022 Aug 30;80(9):915-917. doi: 10.1016/j.jacc.2022.05.052. J Am Coll Cardiol. 2022. PMID: 36007990 No abstract available.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical