Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.396
Peer-review started: November 21, 2018
First decision: December 9, 2018
Revised: December 27, 2018
Accepted: January 8, 2019
Article in press: January 8, 2019
Published online: February 6, 2019
Cardiac resynchronization therapy (CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.
This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block. Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.
Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.
Core tip: Current guidelines are based on adults, which do not enroll pediatric patients for recommendation of cardiac resynchronization therapy, making it more difficult to accurately assess its curative effects. Moreover, the physiological characteristics of children cause a higher risk in surgery compared with adults. In January 2015, the Cardiology Department of Guizhou Provincial People's Hospital implemented biventricular pacing for the first time in one child with heart failure due to right ventricular pacing. The cardiac function of the child improved significantly after upgrading the pacemaker.