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.
Highlights
Chronic 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
Congenital atrioventricular (AV) block quite often is associated with other congenital heart diseases [13,14,15], studies were mostly focused on patients with isolated congenital AV block [8,9,10,11,12,13,14,15,16]. The aim of this retrospective study was to assess the evolution of left ventricular (LV) function in a mixed pediatric pacemaker population with and without structural heart disease
The main finding of this study is that right ventricular (RV) apical pacing in children with or without structural heart disease during a mid-term follow-up does not cause significant decrease in LV function as represented by the shortening fraction
Summary
Chronic 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. Permanent RV pacing may have detrimental effect on LV function and may promote to heart failure in adult patients with LV dysfunction [1,2,3,4,5,6,7,8,9,10]. The effect of chronic RV apical pacing on LV performance in pediatric patients, increasingly reported, is not fully investigated yet. Data about this are controversial [5,8,11,12]. The aim of this retrospective study was to assess the evolution of LV function in a mixed pediatric pacemaker population with and without structural heart disease
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