Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated congenital heart block: a medium term follow-up

Vătăşescu, Radu; Shalganov, Tchavdar; Paprika, Dóra; Környei, László; Prodán, Zsolt; Bodor, Gábor; Szatmári, András; Szili-Török, Tamás

doi:10.1093/europace/eum008

Cited by 37 publications

(29 citation statements)

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“…During chronic RV pacing in children, LV function, morphology [30,31], and histology [15] are at risk for deterioration over time (for review see Karpawich [16]). Chronic RV pacing can eventually result in cardiac failure, which occurs in 6% to 7% of children [17,20,38]. Also, in adults, chronic RV apex pacing has deleterious effects (for review see Manolis [19]) and increases the risk of heart failure [1,28].…”

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confidence: 99%

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2 9 LV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7% ± 6.0%) than in the LVP (32.2% ± 5.2%) or control (29.3% ± 4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8 ± 0.2) than in the LVP (1.4 ± 0.1) or control (1.4 ± 0.2) children. The SPWMD was significantly larger in the RVP (338 ± 20 ms) than in the LVP (-16 ± 14 ms) or control (-5 ± 35 ms) group, whereas QRS duration was similarly longer in the RVP (157 ± 10 ms) and LVP (158 ± 22 ms) groups compared than in the control group (69 ± 7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.Keywords Cardiac function Á Children Á Dyssynchrony Á Pacing Á Site Á Ventricular In children and adults with congenital or acquired atrioventricular (AV) block, the ventricular pacing lead is traditionally positioned at the right ventricle (RV) [16,19]. However, RV apex pacing causes an acute decrease in left ventricular (LV) function in animals [26], adults [6] and children [14,36]. During chronic RV pacing in children, LV function, morphology [30,31], and histology [15] are at risk for deterioration over time (for review see Karpawich [16]). Chronic RV pacing can eventually result in cardiac failure, which occurs in 6% to 7% of children [17,20,38]. Also, in adults, chronic RV apex pacing has deleterious effects (for review see Manolis [19]) and increases the risk of heart failure [1,28].Recognition of the possible harmful effects from RV apex pacing initiated the search for alternative ventricular pacing sites including the RV outflow tract, His bundle, LV wall, and biventricular pacing. Pacing at the His bundle is likely the superior approach [8], but appears to be

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Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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“…LVSF (%) and QRS duration (ms) were measured before and at the last visit after pacemaker implantation. According to a previously published cut-off value, 8 patients were divided into two groups: group A, those with an LVSF reduction at the last echocardiogram at least 7%; group B, patients with stable LVSF (change at the last echocardiogram <7%).…”

Section: Study Patientsmentioning

confidence: 99%

“…[3][4][5][6] However, the effect of chronic right ventricular pacing on left ventricular function in pediatric patients is still controversial. [7][8][9][10][11][12] Thus, the aim of this study was to assess the changes in left ventricular systolic function in young patients (age 20 years) paced for isolated CAVB and to identify possible predictors of left ventricular systolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular function and right ventricular pacing for isolated congenital heart block

Salvo

Issa

Manea

et al. 2013

Journal of Cardiovascular Medicine

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BACKGROUND: Right ventricular pacing has been the treatment of choice in patients with congenital complete atrioventricular block (CAVB). However, the effect of chronic right ventricular pacing on left ventricular function in young patients is still controversial. AIM: The aim of the study was to assess the change in left ventricular systolic function in young patients (age ≤20 years) paced for isolated CAVB and to identify possible predictors of left ventricular systolic dysfunction. METHODS: We studied 55 young patients who underwent permanent right ventricular pacemaker implantation for CAVB in the absence of significant structural heart disease. We excluded patients affected by any condition known to affect left ventricular function. Echocardiographic data prior to and after pacemaker implantation were obtained. RESULTS: The mean age at the time of pacemaker implantation was 20 months, range 2.3-72 months. The mean duration of follow-up was 94.86 (range: 2-268 months). Chronic right ventricular pacing affected left ventricular shortening fraction (LVSF) significantly (pre = 37.8 ± 7.8 vs. post = 32.8 ± 5.5%, P = 0.0036). In 14 patients (25.4%), LVSF decreased by at least 7% (group A). The only parameter studied able to significantly discriminate the two groups was a better baseline LVSF in group A (baseline LVSF: 42.1 ± 5.2 vs. 32.2 ± 2.2%, P = 0.019; cut-off value >39%, P <0.0001; area under the curve = 0.887). CONCLUSION: Chronic right ventricular pacing in young patients without significant structural heart disease is responsible for a significant reduction in left ventricular systolic function, especially in patients with a good baseline LVSF. These patients need close follow-up not only for pacing parameters but also for left ventricular functional evaluation.

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“…The important question which has arisen following recent reports of pacing-induced cardiomyopathy is: should permanent pacing from the RV apex (for transvenous systems) Moak et al, 2006;Beaufort-Krol et al, 2007;Kim et al, 2007;Vatasescu et al, 2007;Gebauer et al, 2009). Most studies found an incidence of dilated cardiomyopathy and LV dilation in 6.0 to 13.4% of children after long-term pacing.…”

Section: Should Right Ventricular Apical Pacing Be Avoided In Childrementioning

confidence: 99%

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

Cate¹,

Sreeram²

2011

Modern Pacemakers - Present and Future

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Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated congenital heart block: a medium term follow-up

Cited by 37 publications

References 28 publications

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Left ventricular function and right ventricular pacing for isolated congenital heart block

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

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