Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site A Multicenter Study

Jan Janousek*, Irene E. van Geldorp, Sylvia Krupickova, Eric Rosenthal, Kelly Nugent, Maren Tomaske, Andreas Fruh, Jan Elders, Anita Hiippala, Gunter Kerst, Roman A. Gebauer, Peter Kubus, Patrick Frias, Fulvio Gabbarini, Sally-Ann Clur, Bert Nagel, Javier Ganame, John Papagiannis, Jan Marek, Svjetlana Tisma-DupanovicSabrina Tsao, Jan-Hendrik Nuernberg, Christopher Wren, Mark Friedberg, Maxime de Guillebon, Julia Volaufova, Frits W. Prinzen, Tammo Delhaas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background-We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing. Methods and Results-One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3-15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1-8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (R=0.80, P=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07-55.60; P=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction >= 55%; odds ratio, 8.26; confidence interval, 1.46-47.62; P=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction. Conclusions-The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function. (Circulation. 2013;127:613-623.)
Original languageEnglish
Pages (from-to)613-623
Issue number5
Publication statusPublished - 5 Feb 2013


  • heart block
  • heart failure
  • pacemakers
  • pacing
  • pediatrics

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