Related Experiment Video
Updated: May 29, 2026
Translational Rabbit Model of Chronic Cardiac Pacing
Published on: January 6, 2023
Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre
Irene E van Geldorp1, Tammo Delhaas, Roman A Gebauer
1Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, PO Box 616, Maastricht NL-6200, The Netherlands. i.vangeldorp@maastrichtuniversity.nl
Insights
In children with heart block, left ventricular pacing improved cardiac function compared to right ventricular pacing. This study highlights pacing site importance for pediatric cardiac health.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Chronic right ventricular (RV) pacing negatively impacts cardiac function.
- Understanding pacing effects is crucial for pediatric patients with heart conditions.
Purpose of the Study:
- To investigate the impact of ventricular pacing site on left ventricular (LV) function in children with isolated atrioventricular (AV) block.
- To compare LV function based on epicardial or endocardial RV pacing versus epicardial LV pacing.
Main Methods:
- Retrospective analysis of 297 children with isolated AV block undergoing chronic ventricular pacing (>1 year) across 27 centers.
- Echocardiographic measurements of LV dimensions and volumes collected, calculating LV fractional shortening (LVFS) and LV ejection fraction (LVEF).
- Linear regression analyses adjusted for patient characteristics to assess pacing site influence.
Main Results:
- LVFS was significantly higher with LV epicardial pacing (LVepi) compared to RV endocardial (RVendo) and epicardial (RVepi) pacing.
- Subnormal LVFS (<28%) was observed in 14% of RVendo and 14% of RVepi patients, but in 0% of LVepi patients (p=0.049).
- Similar trends were observed for LVEF, with a higher proportion of LVepi-paced patients maintaining normal LVEF (≥50%).
Conclusions:
- Ventricular pacing site is a key determinant of LV function in pediatric patients with isolated AV block.
- Left ventricular pacing demonstrates superior outcomes for LV function compared to right ventricular pacing in this cohort.
- Optimizing pacing site selection is essential for preserving cardiac function in children requiring chronic ventricular pacing.
Background:
Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function.
Objective:
In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated.
Methods:
Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics.
Results:
From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients.
Conclusion:
In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.
