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Does chronic pacing affect exercise capacity after Mustard operation for transposition of the great arteries?
M S Silvetti1, F Drago, E Pastore
1Dipartimento di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesú, Roma, Italy.
Insights
Chronic pacing in Mustard repair patients does not impair exercise capacity if spontaneous rhythm is restored during activity. This finding is crucial for understanding long-term outcomes in congenital heart disease survivors.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Electrophysiology
Background:
- Late survival after Mustard repair for transposition of the great arteries (TGA) is generally good.
- However, patients often experience progressive ventricular dysfunction and late arrhythmias, frequently necessitating permanent pacing.
- The impact of chronic pacing on long-term exercise capacity in these patients remains an important clinical question.
Purpose of the Study:
- To evaluate the effect of chronic pacemaker use on long-term exercise capacity in patients who underwent Mustard repair for TGA.
- To compare exercise performance between paced and non-paced patients with TGA after Mustard repair.
Main Methods:
- A comparative study involving two groups of patients post-Mustard repair: 12 non-paced and 18 chronically paced individuals.
- Comprehensive evaluation included medical history, physical examination, electrocardiography, Holter monitoring, and echocardiography.
- Exercise testing assessed exercise tolerance, heart rate, blood pressure, oxygen consumption, and cardiac output at rest and peak exercise.
Main Results:
- No significant differences in exercise tolerance or cardiovascular parameters were observed between the paced and non-paced groups.
- In the paced group, most patients exhibited sinus rhythm during exercise, with some showing junctional rhythm or continuous pacing.
- Pacemaker function was normal in all patients within the paced group.
Conclusions:
- Chronically paced patients with Mustard repair who restore spontaneous sinus rhythm during exercise do not exhibit reduced exercise tolerance compared to non-paced counterparts.
- These findings suggest that effective pacing strategies that allow for appropriate rate response can maintain adequate exercise capacity in TGA survivors.
Abstract:
Late survival after Mustard repair of transposition of the great arteries is generally good but is often characterized by progressive deterioration of ventricular function and by late postsurgical arrhythmias, thus imposing the need for permanent pacing. To evaluate how chronic pacing affects long-term exercise capacity, we compared two groups of these patients: group 1, comprising 12 patients, aged 9.0 +/- 2.6 years, without pacemaker; and group 2, comprising 18 patients, aged 9.3 +/- 2.0 years, with pacemaker. Patient evaluation included history, physical examination electrocardiograph, Holter monitoring, and echocardiography. Pacing modes were as follows: AAI (6 patients), AAIR (9 patients), VVI (2 patients), and VVIR (1 patient). At exercise test we evaluated exercise tolerance, maximum heart rate, blood pressure, oxygen consumption, and cardiac output at rest and at peak exercise. The two groups were comparable for all variables examinated. All pacemakers showed normal function. During the exercise, 11 of 12 patients in group 1 showed sinus rhythm, and in group 2, 11 patients showed sinus rhythm, 5 junctional rhythm, and 2 continuous pacing. There were no significant differences between groups. Chronically paced Mustard patients but with restoration of spontaneous rhythm during the exercise test do not show reduced exercise tolerance in comparison with nonpaced Mustard patients.