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Objective: Pacing in a univentricular circulation has been associated with worsened outcomes. We investigated the long‐term outcomes of pacing in children with a univentricular circulation compared to a complex biventricular circulation. We also identified predictors of adverse outcomes. Methods: A retrospective study of all children with major congenital heart disease who underwent pacemaker implantation under the age of 18 years between November 1994 and October 2017. Results: Eighty‐nine patients were included; 19 with a univentricular and 70 with a complex biventricular circulation. A total of 96% of pacemaker systems were epicardial. Median follow up was 8.3 years. The incidence of adverse outcome was similar between the two groups. Five (5.6%) patients died and two (2.2%) underwent heart transplantation. Most adverse events occurred within the first 8 years after pacemaker implantation. Univariate analysis identified five predictors of adverse outcomes in the patients in the biventricular but none in the univentricular group. The predictors of adverse outcome in the biventricular circulation were a right morphologic ventricle as the systemic ventricle, age at first congenital heart disease (CHD) operation, number of CHD operations, and female gender. The nonapical lead position was associated with a much higher risk of an adverse outcome. Conclusions: Children with a pacemaker and a complex biventricular circulation have similar survival to the ones with a pacemaker and a univentricular circulation. The only modifiable predictor was the epicardial lead position on the paced ventricle, emphasizing the importance of apical placement of the ventricular lead. [ABSTRACT FROM AUTHOR]

Nowadays, fluoroscopy is the standard tool used to help physicians during pacing lead implantation. However, its use entails significant radiation exposure for physicians and especially for patients. For the first time, the present case report describes the use of the electro‐anatomical mapping (EAM) navigation system KODEX‐EPD for cardiac resynchronization therapy (CRT) implantation. These findings suggest that CRT implantation guided by the KODEX‐EPD system is feasible and safe with the minimization of X‐ray and dye exposure. [ABSTRACT FROM AUTHOR]

Objectives: We tested a circumferential mechanical dyssynchrony index (circumferential uniformity ratio estimate [CURE]; 0 to 1, 1 = synchrony) derived from magnetic resonance-myocardial tagging (MR-MT) for predicting clinical function class improvement following cardiac resynchronization therapy (CRT). Background: There remains a significant nonresponse rate to CRT. MR-MT provides high quality mechanical activation data throughout the heart, and delayed enhancement cardiac magnetic resonance (DE-CMR) offers precise characterization of myocardial scar. Methods: MR-MT was performed in 2 cohorts of heart failure patients with: 1) a CRT heart failure cohort (n = 20; left ventricular ejection fraction of 0.23 ± 0.057) to evaluate the role of MR-MT and DE-CMR prior to CRT; and 2) a multimodality cohort (n = 27; ejection fraction of 0.20 ± 0.066) to compare MR-MT and tissue Doppler imaging septal-lateral delay for assessment of mechanical dyssynchrony. MR-MT was also performed in 9 healthy control subjects. Results: MR-MT showed that control subjects had highly synchronous contraction (CURE 0.96 ± 0.01), but tissue Doppler imaging indicated dyssynchrony in 44%. Using a cutoff of <0.75 for CURE based on receiver-operator characteristic analysis (area under the curve: 0.889), 56% of patients tested positive for mechanical dyssynchrony, and the MR-MT CURE predicted improved function class with 90% accuracy (positive and predictive values: 87%, 100%); adding DE-CMR (% total scar <15%) data improved accuracy further to 95% (positive and negative predictive values: 93%, 100%). The correlation between CURE and QRS duration was modest in all cardiomyopathy subjects (r = 0.58, p < 0.001). The multimodality cohort showed a 30% discordance rate between CURE and tissue Doppler imaging septal-lateral delay. Conclusions: The MR-MT assessment of circumferential mechanical dyssynchrony predicts improvement in function class after CRT. The addition of scar imaging by DE-CMR further improves this predictive value. [Copyright &y& Elsevier]

Potential candidates for cardiac resynchronization therapy (CRT) include patients with symptomatic congestive heart failure despite optimal medical therapy, who also have evidence of ventricular dyssynchrony, particularly left bundle branch block, with QRS duration in excess of 150 ms. Dyssynchrony may additionally be identified by echo-Doppler examination and tagged magnetic resonance imaging. Improved exercise capacity and quality of life, reduced sympathetic activation and fewer ventricular tachyarrhythmias are potential benefits of CRT. Ongoing trial results will be required to refine patient selection criteria and to demonstrate the possibility for prognostic as well as symptomatic benefit. [Copyright &y& Elsevier]