Related Experiment Videos
Left ventricular dysfunction after long-term right ventricular apical pacing in the young.
M V Tantengco1, R L Thomas, P P Karpawich
1Division of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA. mtanteng@dmc.org
Journal of the American College of Cardiology
|June 23, 2001
Summary
Long-term right ventricular (RV) apical pacing in young patients impairs global left ventricular (LV) function, as shown by reduced fractional area of change (FAC) and increased myocardial performance index (MPI). Alternative pacing sites are recommended for pediatric patients.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Echocardiography
Background:
- Short-term right ventricular (RV) apical pacing is linked to reduced left ventricular (LV) pump function and relaxation due to asynchronous contraction.
- The long-term impact of RV apical pacing on global LV function in young individuals is not well understood.
Purpose of the Study:
- To evaluate the long-term effects of RV apical pacing on global LV function in pediatric patients.
- To compare LV function in young patients with long-term RV apical pacing against age- and body surface area-matched controls.
Main Methods:
- Assessed global LV function in 24 RV-apex-paced patients (1-19 years follow-up) using echocardiography-derived fractional area of change (FAC) and Doppler index of myocardial performance (MPI).
- Compared data from 24 RV-paced patients (mean follow-up 9.5 years) with 33 age- and BSA-matched controls.
- Utilized multiple linear regression to identify patient variables influencing LV function indexes.
Main Results:
- Long-term RV apical pacing (median follow-up 10 years) resulted in significantly impaired LV systolic and diastolic function compared to controls (FAC: 52% vs. 60%, p < 0.01; MPI: 0.46 vs. 0.34, p < 0.01).
- Paced QRS duration and patient age were significant predictors of global LV contraction (R2 = 0.4, p < 0.05).
Conclusions:
- Long-term RV apical pacing in young patients leads to impaired global LV function.
- Exploring alternative ventricular pacing sites that mimic biventricular activation is crucial for preserving cardiac function in pediatric patients requiring long-term pacing.