Pacemaker Syndrome in the Young:

Abstract

The aim of this study was to determine if single chamber rate responsive ventricular pacing (VVIR) predisposes growing children to develop pacemaker syndrome (PS), and if so, what are determining factors and/or clinically useful predictors. PS is a constellation of symptoms that result from the lack of consistent AV sequential filling due to atrial contraction against closed AV valves. PS has not been commonly reported in the young. Data from all patients with pacemakers with congenital complete atrioventricular block (CAVB) with normal anatomy, and those with congenital heart disease (CHD), and surgically acquired CAVB were reviewed. Inclusion criteria were normal ventricular function by cardiac ultrasound and 100% VVIR pacing. Of 89 patients with VVIR pacemaker implants, 33 met these criteria. Of these, 19 developed PS. For statistical analysis, chi-square and independent samples t-test was used with significance defined at P < or = 0.05. No consistent association was found between cardiac anatomy, type of CAVB, or age at implant with development of PS. However, PS did correlate with duration of pacing (P = 0.02). The exercise stress test showed significant differences between 100% VVIR-paced patients with and without PS, in terms of work rate (P = 0.002) and measured oxygen consumption (P = 0.01). This study shows that PS appears to be a time related event in younger children with normal ventricular function who are 100% ventricular paced. Thus, this supports VVIR pacing as an adequate and cost-effective initial therapy for symptomatic bradycardia due to CAVB.

Rate‐adapting pacing in a 7‐year‐old boy using ventricular contractility information

“…In the fi rst decade the use of single-chamber, accelerometric rate-responsive PM (ventricular pacing, ventricular sensing, inhibition response, rate-adaptive; VVIR ) is an adequate and cost-effective solution: only a few VVIR patients report PM symptoms within 10 years after implantation. 2 Notwithstanding these interesting results, the benefi t of dual-chamber rate-responsive pacing (atrial and ventricular pacing, atrial and ventricular sensing, inhibition and tracking response, rate-adaptive; DDDR ), particularly in adolescents and young adults, would suggest the upgrading procedure. 3,4 This procedure involves various complications, mainly related to the choice and positioning of leads.…”

Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease

“…When pacing is initiated in early childhood for symptomatic bradycardia, patients with CCAVB and normal ventricular contractility may require only rate‐responsive ventricular in deference to atrioventricular (AV) pacing. Initial pacing using the current era of efficient steroid‐eluting leads can later be upgraded to dual‐chamber pacing in adolescence to permit AV synchrony and potentially prevent the development of pacemaker syndrome 9 . Previous controversies and recommendations for endo‐ or epicardial approaches due to vascular versus pacing lead diameters have been somewhat settled with the recent introduction of small 4‐Fr diameter leads 10 .…”

Single Versus Dual Chamber Pacing in the Young:

“…The acute advantages of atrial synchronous activation have been previously described in young patients requiring pacemaker therapy 11 . It has been recently demonstrated that young patients with adequate systemic ventricular function tolerated VVI,R pacing for a considerable period of time before developing clinical symptoms of pacemaker syndrome 12 . Therefore, this study was undertaken to evaluate changes in left ventricular systolic and diastolic function in young RV‐paced patients before and after establishment of atrial synchrony.…”