{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:20:52Z","timestamp":1790716852573,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T00:00:00Z","timestamp":1503705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Right ventricular (RV) apical (RVA) pacing can induce left ventricular (LV) dyssynchrony, remodeling, and dysfunction in children with complete atrioventricular block (CAVB). We compared the functional outcome of RVA with RV alternative pacing sites (RVAPS), including para\u2010Hisian, septal, and outflow tract sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a single\u2010center, retrospective study. Data were collected before pacemaker implantation (transvenous leads), postoperatively, at 6\u00a0months, and at 1\u20132\u20133\u20134 years. Electrocardiogram evaluation included QRS duration, axis, QTc\/JTc, and QTc dispersion. Echocardiographic evaluation included 2\u2010D\/3\u2010D assessment of ventricular dimensions (Z\u2010score of LV end\u2010diastolic dimension), function (ejection fraction), and synchrony.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 2009 to 2015, 55 patients with CAVB, aged 3\u201317 years, with or without other congenital heart defects, underwent RVAPS (30 patients, median age 11 years) or RVA (25 patients, median 12 years). All leads were positioned into the septum. Before implantation, no significant differences in parameters were observed, except for higher Z\u2010score in RVAPS than in RVA. After implantation, at a median follow\u2010up of 2.5 (range 1\u20136) years, the two groups showed no significant differences in LV dimensions, contractility, and synchrony. QRS intervals of RVAPS were significantly shorter than RVA. Clinical status was good and contractility\/synchrony indexes were normal or adequate in all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In pediatric patients, RVAPS and RVA showed no significant differences in LV dimensions, contractility, and synchrony. Preimplantation dilated patients showed LV reverse remodeling. RVAPS demonstrated shorter QRS intervals. Therefore, septal pacing sites, either RVA or RVAPS, seem to determine good contractility and synchrony at a mid\u2010term follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13153","type":"journal-article","created":{"date-parts":[[2017,7,26]],"date-time":"2017-07-26T04:22:44Z","timestamp":1501042964000},"page":"995-1003","source":"Crossref","is-referenced-by-count":12,"title":["What endocardial right ventricular pacing site shows better contractility and synchrony in children and adolescents?"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9284-5972","authenticated-orcid":false,"given":"Massimo Stefano","family":"Silvetti","sequence":"first","affiliation":[{"name":"Pediatric Cardiology and Cardiac Arrhythmias Complex Unit Bambino Ges\u00f9 Children's Hospital and Research Institute  Rome 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