Dual- vs Single-Chamber Ventricular Pacing in Isolated Congenital Complete Atrioventricular Block in Infancy

Reina Bianca Tan; Kristyn A Pierce; James Nielsen; Shubhayan Sanatani; Michael D Fridman; Elizabeth A Stephenson; Sowmith Rangu; Carolina Escudero; Douglas Mah; Allison Hill; Austin M Kane; A Sami Chaouki; Luis Ochoa Nunez; Sit-Yee Kwok; Sabrina Tsao; Dania Kallas; S Yukiko Asaki; Shashank Behere; Anne Dubin; Christopher Ratnasamy; Jeffrey A Robinson; Christopher M Janson; Frank Cecchin; Maully J Shah

doi:10.1016/j.jacep.2024.12.025

Dual- vs Single-Chamber Ventricular Pacing in Isolated Congenital Complete Atrioventricular Block in Infancy

JACC Clin Electrophysiol. 2025 May;11(5):987-998. doi: 10.1016/j.jacep.2024.12.025. Epub 2025 Feb 26.

Authors

Reina Bianca Tan¹, Kristyn A Pierce², James Nielsen², Shubhayan Sanatani³, Michael D Fridman⁴, Elizabeth A Stephenson⁵, Sowmith Rangu⁶, Carolina Escudero⁷, Douglas Mah⁸, Allison Hill⁹, Austin M Kane¹⁰, A Sami Chaouki¹¹, Luis Ochoa Nunez¹², Sit-Yee Kwok¹³, Sabrina Tsao¹³, Dania Kallas³, S Yukiko Asaki¹⁴, Shashank Behere¹⁵, Anne Dubin¹⁶, Christopher Ratnasamy¹⁷, Jeffrey A Robinson¹⁸, Christopher M Janson¹⁹, Frank Cecchin², Maully J Shah¹⁹

Affiliations

¹ Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA. Electronic address: reina.tan@nyulangone.org.
² Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA.
³ Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁴ Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta Canada.
⁵ Department of Paediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto Department of Paediatrics, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, The University of Texas at Austin and Dell Children's Medical Center, Austin, Texas, USA.
⁷ Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Pediatrics, Boston Children's Hospital; Harvard Medical School, Boston Massachusetts, USA.
⁹ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹¹ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹² Department of Pediatrics, The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USA.
¹³ Department of Pediatrics, Hong Kong Children's Hospital, The University of Hong Kong, Hong Kong, China.
¹⁴ Department of Pediatrics, University of Utah/Primary Children's Hospital, Salt Lake City, Utah, USA.
¹⁵ Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, USA.
¹⁶ Department of Pediatrics, Stanford University, Pediatric Cardiology, Palo Alto, California, USA.
¹⁷ Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.
¹⁸ Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
¹⁹ Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 40019417
DOI: 10.1016/j.jacep.2024.12.025

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.

Keywords: congenital; heart block; pacemaker; pediatrics.

Publication types

Multicenter Study
Comparative Study

MeSH terms

Atrioventricular Block* / congenital
Atrioventricular Block* / therapy
Cardiac Pacing, Artificial* / adverse effects
Cardiac Pacing, Artificial* / methods
Female
Heart Block / congenital
Heart Ventricles / physiopathology
Humans
Infant
Infant, Newborn
Male
Pacemaker, Artificial
Retrospective Studies
Treatment Outcome
Ventricular Dysfunction, Left / epidemiology
Ventricular Dysfunction, Left / etiology

Supplementary concepts

Congenital heart block