Comparison of septal vs hisian ventricular synchrony in paediatric patients

Abstract

Abstract Background Long-term right ventricular stimulation is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatrics and congenital heart diseases. Research has shown that pacemaker-induced cardiomyopathy can be reversed with stimulation of the Bundle of His in-adult's, however the available information on it's use in pediatrics is scarce. In this study, pacemaker carriers were analyzed over a period of 26 months to set up a protocol for improving the quality of life of patients undergoing this type of procedure. Introduction Cardiac stimulation initially arose with the aim of correcting the hemodynamic instability caused by the low cardiac output resulting from complete atrioventricular block, the next objective sought was to obtain atrioventricular synchrony and with it a more physiological functioning. Stimulation in the Bundle of His and the hisian zone induces a physiologically normal sequence of activation and thus prevents damage associated with the asynchronous pattern. Material and methods We reviewed 21 pediatric patients with pacemakers of stimulation in the Bundle of His and right septal stimulation that had echocardiographic assessment of ventricular function, as well as the assessment of ventricular synchrony. The study period included was from June 2019 to August 2021. Results The total number of patients was 21 of whom 52.4% (11) were carriers of Hisiana stimulation pacemakers, 47.6% (10) with septal pacemakers. Ventricular function was correlated between both groups without obtaining significant relevance. We obtained significant relevance in the evaluation of atrioventricular asynchrony obtaining a P<0.05 (P=0.01), as well as intraventricular synchrony with a P<0. 05 (p=0. 07). Conclusions The site of ventricular stimulation is the major determinant of the presentation or deterioration of asynchrony and ventricular function in the pediatric population. With this study we can conclude that the pacemakers of hisian stimulation are the ones that are closest to cardiac physiological activation and maintain ventricular and intraventricular atrio synchrony for a better ventricular function. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Instituto Mexicano del Seguro Social- Centro Medico Nacional de Occidente - UMAE Pediatria.