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Exercise performance in young patients with complete atrioventricular block: the relevance of synchronous atrioventricular pacing

Published online by Cambridge University Press:  22 January 2016

M. Cecilia Gonzalez Corcia ,
Lorraine Saint Remy ,
Sebastien Marchandise  and
Stephane Moniotte
M. Cecilia Gonzalez Corcia*
Affiliation:
Department of Pediatric Cardiology, Cliniques Universitaires St Luc, Bruxelles, Belgium
Lorraine Saint Remy
Affiliation:
Department of Pediatric Cardiology, Cliniques Universitaires St Luc, Bruxelles, Belgium
Sebastien Marchandise
Affiliation:
Department of Pediatric Cardiology, Cliniques Universitaires St Luc, Bruxelles, Belgium
Stephane Moniotte
Affiliation:
Department of Pediatric Cardiology, Cliniques Universitaires St Luc, Bruxelles, Belgium
*
Correspondence to: M. C. Gonzalez, Department of Pediatric Cardiology, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium. Tel: +003227641380; Fax: +003227648911; E-mail: [email protected]
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Abstract

At present, there are many pacing strategies for young patients with complete atrioventricular block. The most frequent policy is to attempt placing a dual-chamber system when possible; however, there is a group of patients that is functioning with a non-synchronous ventricular pacing, raising the question of the ideal timing to upgrade their systems. We investigated the exercise performance of a group of children and young adults with complete atrioventricular block and dual-chamber pacemakers in both single- and dual-chamber pacing modalities. A total of 15 patients performed maximal exercise stress testing after programming the VVIR or DDD modes with 2 hours of interval in a double-blind study protocol.

Compared with VVIR pacing, DDD pacing resulted in increase in the peak VO2, longer test duration, major increase in the heart rate achieved during peak exercise, decreased systemic non-invasive arterial blood pressure measured at maximal exercise, higher maximal workload, prolongation of the anaerobic threshold timing, and better self-rated performance perception in all the patients.

Synchronous atrioventricular pacing contributes to an increase in both the exercise performance and the performance perception in 100% of the patients. This difference contributes to create a sense of “fitness” with repercussions in the overall health, self-esteem, and life quality, as well as encourages youngster to practice sports. Our experience tends to favour upgrading patients’ systems to dual-chamber systems before reaching the adolescent years, even if the centre policy is to prolong as long as possible the epicardial site in order to avoid long years of right ventricular pacing.

Keywords

Complete heart blockpacemakerexercise stress test
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1066 - 1071
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Copyright
© Cambridge University Press 2016 

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