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Pacemaker therapy in isolated congenital complete atrioventricular block.
Johannes M P J Breur1, Floris E A Udink Ten Cate, Livia Kapusta
1Department of Pediatric Cardiology, Wilhelmina Children's Hospital/UMC, Utrecht, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|January 11, 2003
Summary
Pacemaker therapy in congenital complete atrioventricular block (CCAVB) patients significantly improves heart size and function. This study suggests reevaluating pacemaker implantation in asymptomatic CCAVB patients with enlarged hearts and reduced cardiac function.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Congenital complete atrioventricular block (CCAVB) often necessitates pacemaker (PM) implantation.
- The optimal timing for PM implantation in CCAVB patients remains a subject of debate.
Purpose of the Study:
- To assess the impact of PM therapy on cardiac dimensions and function in patients with isolated CCAVB.
- To compare the effects of PM therapy in symptomatic versus asymptomatic CCAVB patients.
Main Methods:
- Retrospective analysis of 149 CCAVB patients undergoing PM implantation.
- Evaluation of left ventricular end-diastolic diameter (LVEDD), shortening fraction (SF), and cardiothoracic ratio (CTR) before, during, and after PM therapy.
- Comparison of outcomes between patients with and without PM implantation, and between symptomatic and asymptomatic groups.
Main Results:
- PM therapy was associated with a significant decrease in LVEDD (0.88%/month) and CTR (0.19%/month), and normalization of SF (0.32%/month).
- Asymptomatic patients showed a significant reduction in LVEDD (P < 0.001) and CTR (P < 0.001) after PM implantation.
- Symptomatic patients did not exhibit significant changes in LVEDD post-PM therapy, but CTR significantly decreased (P < 0.001).
Conclusions:
- Pacemaker implantation in CCAVB patients leads to favorable changes in cardiac size and function.
- Current indications for PM therapy in asymptomatic CCAVB patients with cardiac enlargement and dysfunction may warrant reevaluation.