Reassessing Risk Factors in Pediatric Patients With Pacemakers Implanted for Atrioventricular Block: The Impact of Nonsustained Ventricular Tachycardia.
J Cardiovasc Electrophysiol
; 27(4): 471-9, 2016 Apr.
Article
em En
| MEDLINE
| ID: mdl-27074776
ABSTRACT
INTRODUCTION:
In pediatric patients with pacemakers implanted for atrioventricular block (AVB), nonsustained ventricular tachycardia (NSVT) detected during routine surveillance is a finding of unknown significance. We sought to describe the incidence of NSVT and determine if there was an association between NSVT and adverse outcomes in these patients. METHODS ANDRESULTS:
This is a single-center retrospective study of 136 patients (1971-2013) with pacemakers implanted for advanced and complete AVB. EXCLUSION CRITERIA structural heart disease, diagnoses of myocarditis, cardiomyopathy or channelopathy preceding AVB diagnosis, and sustained or polymorphic ventricular tachycardia (VT) as the first occurring arrhythmia after pacemaker implant. During median follow-up of 11.6 years (IQR 4.3 years, 17 years), 14 (10%) patients had NSVT. There were 6 (4.4%) deaths. Overall, Kaplan-Meier 20-year survival from time of implant was 93%. By univariate analysis, earlier mortality was associated with NSVT (P = 0.010), sustained left ventricular (LV) dysfunction (P = 0.004), maternal autoantibodies (P = 0.017), and acquired AVB (P = 0.049). By multivariate analysis, earlier mortality was associated with NSVT (HR 5.39 [95% CI 1.02-28.41]; P = 0.047) and sustained LV dysfunction (HR 10.24 [95% CI 1.83-57.32]; P = 0.008).CONCLUSIONS:
In children with pacemakers implanted for AVB, NSVT is not uncommon and may be associated with increased mortality. Persistent LV dysfunction may also be a potential factor associated with death. Closer follow-up should be considered in patients with these findings. Large, multicenter studies should be considered to confirm these findings and identify risk stratification methods for this unique patient population.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Marca-Passo Artificial
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Próteses e Implantes
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Taquicardia Ventricular
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Bloqueio Atrioventricular
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Child
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Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Cardiovasc Electrophysiol
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
FISIOLOGIA
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Estados Unidos