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Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated

Radu Vatasescu1, Tchavdar Shalganov, Dora Paprika

  • 1Hungarian Institute of Cardiology, Haller u. 29, 1096-H, Budapest, Hungary.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 14, 2007
PubMed

Insights

Permanent right ventricular apical pacing for congenital heart block in children generally does not impair left ventricular function. However, certain factors like younger age at implantation and higher baseline heart rate may increase the risk of LV function decline.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Congenital Heart Disease

Background:

  • Right ventricular apical pacing (RVAP) is a common treatment for congenital heart block.
  • The long-term effects of RVAP on left ventricular (LV) function in children are not fully understood.
  • Existing adult data suggest RVAP can be detrimental to LV function.

Purpose of the Study:

  • To evaluate the changes in LV systolic function in children with isolated congenital heart block (ICHB) undergoing RVAP.
  • To identify predictors of LV function deterioration in this pediatric population.

Main Methods:

  • Retrospective analysis of 45 children with ICHB and RVAP.
  • Assessment of LV shortening fraction (LV SF) and QRS duration before, immediately after, and during follow-up (mean 58.69 months).
  • Categorization into stable and deteriorating LV SF groups based on a >7% decrease.

Main Results:

  • Overall LV SF did not significantly change during chronic RVAP.
  • Deteriorators (n=13) showed higher baseline heart rate and LV SF compared to stable patients.
  • Younger age at implantation (<2 years), initial epicardial lead, and narrower native QRS were more common in deteriorators.

Conclusions:

  • Permanent RVAP for ICHB is not invariably associated with LV dysfunction in children.
  • Higher baseline heart rate, better baseline LV SF, younger age at pacing, narrower native QRS, and epicardial pacing may predict LV function decline.
Abstract

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