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Left ventricular function and right ventricular pacing for isolated congenital heart block
Giovanni Di Salvo1, Ziad Issa, Waleed Manea
1aKing Faisal Specialist Hospital and Research Center, Heart Center, Pediatric Cardiology bKing Faisal Specialist Hospital and Research Center, Heart Center, Pediatric Cardiac Surgery, Riyadh, Saudi Arabia.
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|May 10, 2013
Summary
Right ventricular pacing in young patients with congenital complete atrioventricular block significantly reduces left ventricular function. Patients with initially good left ventricular shortening fraction are most affected and require close monitoring.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Function Assessment
Background:
- Right ventricular pacing is standard for congenital complete atrioventricular block (CAVB).
- The long-term impact of this pacing on left ventricular function in young patients remains debated.
Purpose of the Study:
- To evaluate changes in left ventricular systolic function in young patients (≤20 years) with isolated CAVB after right ventricular pacemaker implantation.
- To identify predictors of left ventricular systolic dysfunction in this population.
Main Methods:
- Prospective study of 55 young patients with CAVB receiving permanent right ventricular pacemakers.
- Echocardiographic assessments of left ventricular function before and after pacemaker implantation.
- Exclusion of patients with conditions known to affect left ventricular function.
Main Results:
- Chronic right ventricular pacing led to a significant decrease in left ventricular shortening fraction (LVSF) (37.8% to 32.8%, P=0.0036).
- A significant reduction (≥7%) in LVSF was observed in 25.4% of patients.
- Higher baseline LVSF (>39%) was the sole significant predictor of decreased LVSF post-pacing (P=0.019).
Conclusions:
- Right ventricular pacing in young patients with CAVB and no structural heart disease significantly impairs left ventricular systolic function.
- Patients with a baseline LVSF >39% are at higher risk for developing pacing-induced left ventricular dysfunction.
- Close cardiac monitoring, including left ventricular function assessment, is crucial for these young patients.
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