Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
J Card Fail. 2009 Oct;15(8):681-8. doi: 10.1016/j.cardfail.2009.04.002. Epub 2009 May 22.
Pediatric patients paced for complete atrioventricular block (CAVB) are at risk of developing dilated cardiomyopathy (DCM). We sought to explore the role played by the setting of ventricular pacing.
A total of 35 patients <18 years of age at diagnosis were enrolled. Twenty-eight (80%) received pacemakers after a mean follow-up of 10 years, and most were paced from right ventricular (RV) apex (n = 23). None of the 7 patients without pacemakers developed DCM, whereas 8 (35%) paced from RV apex had DCM 2.6 +/- 2.2 years after pacing. The percentage of ventricular pacing was >90% in all patients. Multivariate analysis revealed that the cumulative Z score of lower ventricular rate setting was the single most important risk factor for DCM (HR, 3.14; 95% CI, 1.07-9.19; P = .037). Subgroup analysis in patients with VVI/VVIR modes revealed an even stronger predictive value of the cumulative Z score of lower ventricular rate setting (HR, 9.12; 95% CI, 1.53-54.24; P = .015).
Higher setting of the lower ventricular rate, though still within the age-appropriate range, was associated with increased risk of developing DCM in pediatric patients with CAVB and chronic RV apical pacing.
患有完全性房室传导阻滞（CAVB）的儿科患者有发展为扩张型心肌病（DCM）的风险。我们试图探讨心室起搏设置所起的作用。
共纳入 35 名诊断时年龄<18 岁的患者。28 名（80%）在平均 10 年的随访后接受了起搏器治疗，其中大多数（n = 23）从右心室（RV）心尖起搏。未起搏的 7 名患者中无一例发生 DCM，而 8 名（35%）从 RV 心尖起搏的患者在起搏后 2.6 ± 2.2 年内发生了 DCM。所有患者的心室起搏比例均>90%。多变量分析显示，较低心室率设置的累积 Z 评分是 DCM 的唯一最重要的危险因素（HR，3.14；95%CI，1.07-9.19；P =.037）。在采用 VVI/VVIR 模式的患者亚组分析中，较低心室率设置的累积 Z 评分具有更强的预测价值（HR，9.12；95%CI，1.53-54.24；P =.015）。
尽管仍在年龄适宜范围内，但较低心室率设置较高与 CAVB 和慢性 RV 心尖起搏的儿科患者发生 DCM 的风险增加相关。
