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Differential effects of the site of permanent epicardial pacing on left ventricular synchrony and function in the

Roman A Gebauer1, Viktor Tomek, Petr Kubus

  • 1Department of Pediatric Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, Leipzig, Germany. roman.gebauer@med.uni-leipzig.de

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
|November 10, 2009
PubMed

Insights

Left ventricular apical pacing best preserves synchrony and function in young patients with atrioventricular block. This pacing strategy may be preferred over right ventricular pacing for optimal cardiac performance.

Area of Science:

  • Cardiology
  • Pediatric Electrophysiology
  • Cardiac Mechanics

Background:

  • Epicardial pacing is used in young patients with atrioventricular block.
  • The impact of pacing site on left ventricular (LV) synchrony and function is not fully understood in this population.

Purpose of the Study:

  • To analyze left ventricular (LV) synchrony and function in relation to the epicardial pacing site in pediatric patients.
  • To determine the optimal epicardial pacing site for preserving LV function and synchrony in the young.

Main Methods:

  • Evaluated LV function and synchrony using M-mode and speckle tracking in 32 children with atrioventricular block.
  • Pacing sites included LV apex, right ventricular (RV) apex, and RV free wall.
  • Assessed septal to posterior wall motion delay (SPWMD), septal to lateral mechanical delay, apical to basal mechanical delay, and LV ejection fraction (LVEF).

Main Results:

  • LV apical pacing showed significantly less septal to posterior wall motion delay (0 ms) and septal to lateral mechanical delay (54 ms) compared to RV apical (69 ms, 73 ms) and RV free wall pacing (136 ms, 129 ms).
  • LV ejection fraction was highest with LV apical pacing (57%) and significantly reduced with RV apical (49%) and RV free wall pacing (33%).
  • SPWMD and RV free wall pacing were negative multivariable predictors of LVEF.

Conclusions:

  • Left ventricular apical pacing preserves septal to lateral LV synchrony and systolic function compared to other epicardial pacing sites.
  • LV apical pacing may be the preferred epicardial pacing site in young individuals with atrioventricular block.
  • Optimizing pacing site is crucial for maintaining cardiac function in pediatric patients requiring epicardial pacing.
Abstract

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