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Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in
Tchavdar Nikolov Shalganov1, Dora Paprika, Radu Vatasescu
1Department of Pacing and Clinical Electrophysiology, Gottsegen Gyorgy National Institute of Cardiology, Budapest, Hungary. dr.kardos@t-online.hu
Insights
Chronic right ventricular pacing in children does not generally harm left ventricular function. However, complex congenital heart defects may lead to a decrease in left ventricular shortening fraction over time.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiovascular Research
Background:
- Chronic right ventricular apical pacing may negatively impact left ventricular function and contribute to heart failure in adults with existing left ventricular dysfunction.
- Pediatric patients with pacemakers require careful monitoring for potential cardiac effects.
Purpose of the Study:
- To evaluate the long-term effects of chronic right ventricular pacing on left ventricular function in pediatric patients.
- To assess whether pacing in pediatric patients with or without structural heart disease influences left ventricular shortening fraction.
Main Methods:
- Retrospective study of 99 pediatric patients with pacemakers, categorized by underlying heart condition (atrioventricular block or structural heart disease).
- Follow-up included 12-lead electrocardiogram and transthoracic echocardiography to assess left ventricular shortening fraction and QRS duration.
- Average follow-up duration was 53 months.
Main Results:
- Overall, left ventricular shortening fraction did not significantly change post-pacemaker implantation.
- A significant decrease in left ventricular shortening fraction was observed in patients with complex congenital heart malformations.
- Six patients developed dilated cardiomyopathy during the follow-up period.
Conclusions:
- Chronic right ventricular pacing in pediatric patients, with or without structural heart disease, does not consistently lead to a decline in left ventricular function.
- Pediatric patients with complex congenital heart malformations are at risk for decreased left ventricular function during chronic right ventricular pacing.
Background:
Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction.
Methods:
A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 +/- 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram.
Results:
Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 +/- 0.07 vs 0.35 +/- 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation.
Conclusion:
Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.
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