Squeezing better function out of the systemic right ventricle by optimizing its pacing site

Abstract

The morphologic right ventricle (RV) is the systemic pumping chamber predominantly in 2 types of biventricular congenital heart disease: congenitally corrected transposition of the great arteries and following repair of transposition of the great arteries (TGA) using a Senning or Mustard atrial switch procedure. In both conditions, the systemic RV is prone to fail. Indeed, after the atrial switch procedure for TGA, long-term systemic RV function is a major concern and profoundly affects patient outcomes. Roos-Hesselink et al 1 Roos-Hesselink J.W. Meijboom F.J. Spitaels S.E. et al. Decline in ventricular function and clinical condition after Mustard repair for transposition of the great arteries (a prospective study of 22–29 years). Eur Heart J. 2004; 25: 1264-1270 Crossref PubMed Scopus (198) Google Scholar found that while all patients had good RV function 14 years after undergoing an atrial switch procedure, almost two-thirds showed moderate-to-severe systemic RV dysfunction after 25 years. RV dysfunction was associated with QRS prolongation, a decline in exercise capacity and clinical status and presumably increased need for heart transplant. Reduced myocardial strain and other indices of RV performance form the basis for systemic RV failure in this setting. 2 Eyskens B. Weidemann F. Kowalski M. et al. Regional right and left ventricular function after the Senning operation: an ultrasonic study of strain rate and strain. Cardiol Young. 2004; 14: 255-264 Crossref PubMed Scopus (56) Google Scholar Conversely, RV dysfunction is not commonly seen in the subpulmonary RV when TGA is treated with an arterial switch operation. Therefore, it is the systemic position of the RV that predisposes it to failure. Acute hemodynamic benefits of biventricular and single-site systemic ventricular pacing in patients with a systemic right ventricleHeart RhythmVol. 10Issue 5PreviewPatients treated by atrial redirection surgery (Senning or Mustard procedure) for transposition of the great arteries (TGA) have an important risk for heart failure caused by dysfunction of the systemic right ventricle. Conventional nonsystemic ventricular pacing (non-systVP) may even further increase this risk. Full-Text PDF