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首页> 外文期刊>Circulation journal >Pacing Therapy in Children – Repeat Left Ventricular Pacing for Preservation of Ventricular Function –
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Pacing Therapy in Children – Repeat Left Ventricular Pacing for Preservation of Ventricular Function –

机译：儿童起搏疗法–重复左心室起搏以保持心室功能–

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Background: The importance of ventricular pacing site in pediatric pacemaker therapy has gradually become recognized. We reviewed our experience with a left ventricular (LV)-prioritized pacing strategy. Methods?and?Results: Between 2000 and 2012, 60 patients underwent 76 permanent pacemaker implantations. Eight of the 29 reoperations involved ventricular lead repositioning for pacing-induced ventricular dysfunction. Freedom from ventricular lead failure was 96.3%, 86.8%, and 81.0% at 1, 3, and 5 years, respectively. The independent predictors of ventricular lead failure were age (P=0.026) and peak minimal energy threshold within 6 months (P=0.035). At the measured points, redo bipolar, steroid-eluting leads had significantly better pacing properties than did redo non-steroid-eluting, screw-in leads (P=0.0009–0.03). Ventricular lead repositioning was effective in the 5 patients with systemic LV pacing, whereas its efficacy was inconsistent in patients with single-ventricle or systemic right ventricular (RV) pacing. At a median follow-up of 59 months, the 28 patients with LV pacing had preserved ventricular function (LV fraction shortening, 0.34±0.09). Conclusions: The outcome of this LV-prioritized pacing strategy in pediatric patients was excellent, demonstrating preserved ventricular function. Bipolar, steroid-eluting, epicardial pacing leads achieved good pacing properties, even in reoperation patients. In children with systemic LV and RV pacing-induced ventricular dysfunction, a conversion to LV apex pacing was an attractive alternative to cardiac resynchronization therapy. ( Circ J 2014; 78: 2972–2978)
机译：背景：心室起搏部位在小儿起搏器治疗中的重要性已逐渐为人们所认识。我们回顾了左心室（LV）优先起搏策略的经验。方法和结果：2000年至2012年，60例患者接受了76例永久性起搏器植入。 29例再手术中有8例因起搏引起的心室功能障碍而进行了心室导线的重新定位。在1年，3年和5年时，无心室铅衰竭的发生率分别为96.3％，86.8％和81.0％。心室铅衰竭的独立预测因子是年龄（P = 0.026）和6个月内的最小能量峰值峰值（P = 0.035）。在测量点，重做双极类固醇洗脱导线比起重做非类固醇洗脱旋入导线具有更好的起搏性能（P = 0.0009–0.03）。在5例系统性左室起搏患者中，心室导线重新定位有效，而在单心室或系统性右心室（RV）起搏患者中其疗效不一致。在59个月的中位随访中，这28例左室起搏患者保留了心室功能（左室分数缩短，0.34±0.09）。结论：这种以LV优先的起搏策略在小儿患者中效果极佳，表明心室功能得以保持。双极类固醇洗脱心外膜起搏导线即使在再次手术患者中也具有良好的起搏特性。对于患有全身性LV和RV起搏引起的心室功能不全的儿童，转换为LV顶点起搏是心脏再同步治疗的一种有吸引力的替代方法。 （Circ J 2014; 78：2972–2978）

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