Managed Ventricular Pacing in Pediatric Patients and Patients With Congenital Heart Disease

      Ventricular dyssynchrony induced by ventricular pacing (VP) may predispose patients to congestive heart failure. The detrimental effects of VP are directly related to the cumulative percentage of VP (Cum%VP). Managed VP (MVP) is a novel pacing algorithm developed to minimize unnecessary VP by uncoupling atrial pacing from VP. This retrospective analysis assessed the feasibility of using MVP in pediatric patients and patients with congenital heart disease (CHD). A multicenter review evaluated all pediatric patients <22 years old and older patients with CHD that had an implanted device using a MVP algorithm. Primary outcome variables were Cum%VP and adverse events. A subgroup analysis evaluated patients that had a DDD(R) pacemaker before a MVP device and compared Cum%VP before and after initiation of MVP. From 6 centers 62 patients (mean age 21.5 ± 9.6 years) were included; 64% had CHD. With a MVP device, mean Cum%VP was 4.3 ± 14.6% (range 0 to 83.7): Eleven patients were eligible for subgroup analysis. Compared with DDD(R), Cum%VP significantly decreased with MVP (67.1 ± 29.4% vs 9.2 ± 24.8%, p = 0.002). One MVP-related adverse event occurred; a patient with intermittent atrioventricular block had symptoms with frequent nonconducted atrial depolarizations and was reprogrammed to DDD. In conclusion, MVP can be used safely and can significantly reduce unnecessary VP in pediatric patients and patients with CHD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sweeney M.O.
        • Prinzen F.W.
        A new paradigm for physiologic ventricular pacing.
        J Am Coll Cardiol. 2006; 47: 282-288
        • Sweeney M.O.
        • Shea J.B.
        • Fox V.
        • Adler S.
        • Nelson L.
        • Mullen T.J.
        • Belk P.
        • Casavant D.
        • Sheldon T.
        Randomized pilot study of a new atrial-based minimal ventricular pacing mode in dual-chamber implantable cardioverter-defibrillators.
        Heart Rhythm. 2004; 1: 160-167
        • Sweeney M.O.
        • Ellenbogen K.A.
        • Casavant D.
        • Betzold R.
        • Sheldon T.
        • Tang F.
        • Mueller M.
        • Lingle J.
        Multicenter, prospective, randomized safety and efficacy study of a new atrial-based managed ventricular pacing mode (MVP) in dual chamber ICDs.
        J Cardiovasc Electrophysiol. 2005; 16: 811-817
        • Gillis A.M.
        • Purefrfellner H.
        • Israel C.W.
        • Sunthorn H.
        • Kacet S.
        • Anelli-Monti M.
        • Tang F.
        • Young M.
        • Boriani G.
        Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease.
        Pacing Clin Electrophysiol. 2006; 29: 697-705
        • Wilkoff B.L.
        • Cook J.R.
        • Epstein A.E.
        • Greene H.L.
        • Hallstrom A.P.
        • Hsia H.
        • Kutalek S.P.
        • Sharma A.
        Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial.
        JAMA. 2002; 228: 3115-3123
        • Sweeney M.O.
        • Hellkamp A.S.
        • Ellenbogen K.A.
        • Greenspon A.J.
        • Freedman R.A.
        • Lee K.L.
        • Lamas G.A.
        Adverse effect of ventricular pacing on heart failure and atrial fibrillation in patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.
        Circulation. 2003; 107: 2932-2937
        • Sweeney M.O.
        • Hellkamp A.S.
        Heart failure during cardiac pacing.
        Circulation. 2006; 113: 2082-2088
        • Tantengco M.V.
        • Thomas R.L.
        • Karpawich P.P.
        Left ventricular dysfunction after long-term ventricular apical pacing in the young.
        J Am Coll Cardiol. 2001; 37: 2093-2100
        • Nothroff J.
        • Norozi K.
        • Alpers V.
        • Arnhold J.O.
        • Wessel A.
        • Ruschewski W.
        • Buchhorn R.
        Pacemaker implantation as a risk factor for heart failure in young adults with congenital heart disease.
        Pacing Clin Electrophysiol. 2006; 29: 386-392
        • Nielsen J.C.
        • Kristensen L.
        • Andersen H.R.
        • Mortensen P.T.
        • Pedersen O.
        • Pedersen A.K.
        A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome.
        J Am Coll Cardiol. 2003; 42: 614-623
        • Sweeney M.O.
        • Bank A.J.
        • Nsah E.
        • Koullick M.
        • Zeng Q.C.
        • Hettrick D.
        • Sheldon T.
        • Lamas G.A.
        Minimizing ventricular pacing to reduce atrial fibrillation in sinusnode disease.
        N Engl J Med. 2007; 357: 1000-1008
        • Thambo J.B.
        • Bordachar P.
        • Garrigue S.
        • Lafitte S.
        • Sanders P.
        • Reuter S.
        • Girardot R.
        • Crepin D.
        • Reant P.
        • Roudaut R.
        • Jais P.
        • Haissaguerre M.
        • Clementy J.
        • Jimenez M.
        Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing.
        Circulation. 2004; 110: 3766-3772
        • Kim J.J.
        • Friedman R.A.
        • Eidem B.W.
        • Cannon B.C.
        • Arora G.
        • Smith E.O.
        • Fenrich A.L.
        • Kertesz N.J.
        Ventricular function and long-term pacing in children with congenital complete atrioventricular block.
        J Cardiovasc Electrophysiol. 2007; 18: 373-377