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Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular
Jean-Benoît Thambo1, Pierre Bordachar, Stephane Garrigue
1Hôpital Cardiologique du Haut Lévèque, 19 avenue de Magellan, Pessac Cedex 33604 France. jean-benoit.thambo@chu-bordeaux.fr
Circulation
|December 8, 2004
Summary
Long-term right ventricular pacing (RVP) in complete congenital atrioventricular block (CCAVB) patients causes significant ventricular dyssynchrony, leading to adverse left ventricular remodeling and reduced exercise capacity. This highlights the critical role of the ventricular activation sequence in pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Imaging
Background:
- Dual-chamber pacing benefits CCAVB patients by optimizing heart rate and AV synchronization.
- However, the long-term consequences of asynchronous electromechanical activation from apical RVP remain unclear.
Purpose of the Study:
- To investigate the long-term effects of apical RVP on left ventricular (LV) mechanics and remodeling in adults with CCAVB.
- To assess the impact of RVP-induced dyssynchrony on cardiac function and exercise capacity.
Main Methods:
- Retrospective analysis of 23 CCAVB adults with DDD transvenous pacemakers.
- Echocardiography, tissue Doppler imaging, and tissue tracking before and after at least 5 years of RVP.
- Comparison with 30 matched healthy control subjects.
Main Results:
- Long-term RVP significantly increased intra-LV asynchrony, delayed longitudinal contraction, and septal-to-posterior wall-motion delay compared to controls.
- RVP was associated with increased LV end-diastolic diameter and asymmetrical hypertrophy.
- CCAVB patients with RVP exhibited lower cardiac output and reduced exercise performance than controls.
Conclusions:
- Prolonged RVP induces ventricular dyssynchrony, leading to detrimental LV remodeling, dilatation, hypertrophy, and diminished exercise capacity.
- These findings underscore the importance of the ventricular activation sequence in patients with chronic ventricular pacing.
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