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Does Biventricular Pacing Improve Hemodynamics in Children Undergoing Routine Congenital Heart Surgery?

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Abstract

Biventricular (BiV) pacing or cardiac resynchronization therapy (CRT) is an established therapy for heart failure in adults. In children, cardiac dyssynchrony occurs most commonly following repair of congenital heart disease (CHD) where multisite pacing has been shown to improve both hemodynamics and ventricular function. Determining which patient types would specifically benefit has not yet been established. A prospective, repeated measures design was undertaken to evaluate BiV pacing in a cohort of children undergoing biventricular repair for correction of their CHD. Hemodynamics, arterial blood gas, electrocardiographic (ECG), and echocardiographic data were collected. Pacing protocol was undertaken prior to the patient’s extubation with 20 min of conventional right ventricular (RV) or BiV pacing, preceded and followed by 10 min of recovery time. Multivariate statistics were used to analyze the data with p values <0.05 considered significant. Twenty-five (14 female) patients underwent surgery at a median (range) age of 5.2 (0.1–37.4) months with no early mortality. The Risk-adjusted classification for Congenital Heart Surgery (RACHS) scores were 2 in 14 patients, 3 in eight patients, and 4 in three patients. None had pre-existing arrhythmias, dyssynchrony, or required pacing pre-operatively. No patient required implantation of a permanent pacemaker post-operatively. The median cardio-pulmonary bypass time was 96 (55–236) min. RV and BiV pacing did not improve cardiac index from baseline (3.23 vs. 3.42 vs. 3.39 L/min/m2; p > 0.05). The QRS duration was not changed with pacing (100 vs. 80 vs. 80 ms; p > 0.05). On echocardiography, the time-to-peak velocity difference between the septal and posterior walls (synchrony) during pacing was similar to baseline and was also not statistically significant. BiV pacing did not improve cardiac output when compared to intrinsic sinus rhythm or RV pacing in this cohort of patients. Our study has shown that BiV pacing is not indicated in children who have undergone routine BiV congenital heart surgery. Further prospective studies are needed to assess the role of multisite pacing in children with ventricular dyssynchrony such as those with single ventricles, those undergoing reoperation or those with high RACHS scores.

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Acknowledgments

The authors would like to acknowledge the assistance of Mrs. Mary T. Potts and Mrs. Karen Gibbs for their roles in the completion of this study.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada

    Aamir Jeewa, James E. Potts, Eustace S. DeSouza, A. J. Hollinger, George G. S. Sandor & Shubhayan Sanatani

  2. Division of Critical Care, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Alexander F. Pitfield & Wendy Soulikias

  3. Division of Cardiovascular and Thoracic Surgery, Department of Surgery, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Jacques G. LeBlanc & Andrew M. Campbell

  4. Division of Cardiology, British Columbia’s Children’s Hospital, 1F3–4480 Oak Street, Vancouver, BC, V6H-3V4, Canada

    Shubhayan Sanatani

Authors
  1. Aamir Jeewa
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  2. Alexander F. Pitfield
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  3. James E. Potts
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  4. Wendy Soulikias
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  5. Eustace S. DeSouza
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  6. A. J. Hollinger
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  7. George G. S. Sandor
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  8. Jacques G. LeBlanc
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  10. Shubhayan Sanatani
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Correspondence to Shubhayan Sanatani.

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Jeewa, A., Pitfield, A.F., Potts, J.E. et al. Does Biventricular Pacing Improve Hemodynamics in Children Undergoing Routine Congenital Heart Surgery?. Pediatr Cardiol 31, 181–187 (2010). https://doi.org/10.1007/s00246-009-9581-4

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  • DOI: https://doi.org/10.1007/s00246-009-9581-4

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