Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease

Abstract

BackgroundChronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction.MethodsA group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram.ResultsLeft ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation.ConclusionChronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.

Outcome in young patients with isolated complete atrioventricular block and permanent pacemaker treatment: A nationwide study of 127 patients

“…We found 6 studies, 2,10,12,15,17 including the present study, where the definition of DCM was acceptably transparent and unequivocal, with a total of 54 patients meeting the criteria and 38 males vs 16 females had developed DCM. In our study, 7 of 9 patients developing LV dysfunction were males.…”

Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey

“…In the near future, endocardial pacing in the systemic ventricle may become feasible through the application of ‘wireless pacing’. However, in practice, the routine transvenous approach seems justifiable in young adults, as RV apical pacing is well tolerated by most patients 10 31…”

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

“…Also the percentage of dilated cardiomyopathy developed after pacemaker implantation in our series is comparable to that of previously published studies. [7][8][9][10] Of interest, in our study, comparing patients who showed deterioration of left ventricular global systolic function during the follow-up and those who were stable, the only significant difference was a prepacemaker implantation LVSF more than 39%. This finding is in agreement with both pediatric and adult studies.…”

“…In fact, starting the stimulation early and for a longer period could increase the risk of deterioration of left ventricular systolic function in these patients. Unfortunately, data on the long-term effect of right ventricular pacing in children and adolescents are still debated, [7][8][9][10][11][12][13] probably because of the different methodological criteria (isolated CAVB vs. CAVB associated with other complex congenital heart diseases; follow-up duration; lack of preimplant echo data; echocardiographic assessment performed by different readers; sample size).…”

“…[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.…”