Reassessing risk factors in pediatric patients with pacemakers implanted for atrioventricular block: The impact of nonsustained ventricular tachycardia

Mary C. Niu, Shaine A. Morris, Michele Krenek, Caridad M. De La Uz, Claudia Pedroza, Christina Y. Miyake, Jeffrey J. Kim, Santiago O. Valdés

Research output: Contribution to journalArticle

Abstract

Ventricular Tachycardia and Atrioventricular Block 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 and Results 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.

Original languageEnglish (US)
Pages (from-to)471-479
Number of pages9
JournalJournal of cardiovascular electrophysiology
Volume27
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • LV dysfunction
  • complete atrioventricular block
  • mortality
  • nonsustained ventricular tachycardia
  • pacing
  • sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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