Dual- vs Single-Chamber Ventricular Pacing in Isolated Congenital Complete Atrioventricular Block in Infancy.
Document Type
Article
Publication Date
2025
Publication Title
JACC. Clinical Electrophysiology
Abstract
BACKGROUND: The optimal pacemaker programming strategy for infants with isolated congenital complete atrioventricular block (CCAVB) remains unresolved. Dual-chamber pacing maintains atrioventricular synchrony and physiological heart rate variability but increases the burden of ventricular pacing on a myocardium that may be inherently prone to left ventricular (LV) dysfunction.
OBJECTIVES: This study sought to compare clinical outcomes of dual (DDD)- vs single (VVI)- chamber pacing in infants with CCAVB (DAVINCHI).
METHODS: A multicenter retrospective study (2006-2023) identified infants with CCAVB and pacemaker implant at < 1 year, with single-site ventricular pacing and no significant congenital heart disease. Outcome measured were clinically significant LV dysfunction, mortality, and complications.
RESULTS: A total of 109 infants (64% autoimmune CCAVB) were identified, 60.6% had VVI pacing. Over a median follow-up of 5 years, 60 complications occurred in 47 subjects (43.1%). Smaller infants had more complications. Clinically significant LV dysfunction developed in 11 (10.1%) and was more frequent in DDD (21% vs 3%; P = 0.006). LV dysfunction resulted in mortality in 1 patient and 10 patients required a change in pacing mode. Independent risk factors for LV dysfunction were DDD pacing and neonatal implant. Right ventricular pacing lead placement had a higher HR (HR: 2.67) for LV dysfunction but was not statistically significant (P = 0.20).
CONCLUSIONS: DDD pacing increases LV dysfunction risk compared with VVI in infants with CCAVB. Single-chamber LV apical pacing should be considered in infants with isolated CCAVB who require pacing. There is a high risk of pacing-related complications, particularly with an increased risk of ventricular lead complications in low-weight neonates.
Volume
11
Issue
5
First Page
987
Last Page
998
Recommended Citation
Tan RB, Pierce KA, Nielsen J, Sanatani S, Fridman MD, Stephenson EA, Rangu S, Escudero C, Mah D, Hill A, Kane AM, Chaouki AS, Ochoa Nunez L, Kwok S-Y, Tsao S, Kallas D, et al [Ratnasamy C]. Dual- vs single-chamber ventricular pacing in isolated congenital complete atrioventricular block in infancy. JACC Clin Electrophysiol. 2025;11(5):987-98. doi: 10.1016/j.jacep.2024.12.025. PMID: 40019417
DOI
10.1016/j.jacep.2024.12.025
ISSN
2405-5018
PubMed ID
40019417
Comments
Helen DeVos Children's Hospital