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Diastolic function in paced children with cardiac defects: septum vs apex

Michel Cabrera Ortega1, Adel Eladio Gonzalez Morejon1, Giselle Ricardo Serrano1

  • 1Cardiocentro Pediatrico William Soler, La Habana, CU.

Arquivos Brasileiros De Cardiologia
|September 10, 2015
PubMed

Insights

Right ventricular septal pacing, unlike apical pacing, preserves left ventricular diastolic function in children with congenital heart disease. This finding is crucial for optimizing pacemaker strategies in pediatric cardiology.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Physiology
  • Biomedical Engineering

Background:

  • The impact of chronic ventricular pacing on diastolic function in pediatric patients with structural congenital heart disease (CHD) remains unclear.
  • The superiority of septal pacing over apical pacing is a subject of ongoing debate.

Purpose of the Study:

  • To investigate how different right ventricular (RV) pacing locations affect left ventricular (LV) diastolic function in children with cardiac defects.

Main Methods:

  • A prospective study of 29 pediatric patients with complete atrioventricular block (CAVB) and CHD undergoing permanent pacing.
  • Patients were divided into two groups: RV apex pacing (n=16) and RV septum pacing (n=13).
  • Echocardiographic assessments, including transmitral E-wave and tissue Doppler imaging (TDI) parameters, were performed before and after pacemaker implantation, with a mean follow-up of 4.9 years.

Main Results:

  • RV apical pacing significantly affected transmitral E-wave and lateral annular TDI parameters compared to RV septum pacing.
  • The E' wave showed an inverse correlation with the TDI lateral myocardial performance index (Tei index) (R²=0.9849, p ≤ 0.001).
  • RV apex pacing and elevated TDI lateral Tei index were significant predictors of reduced LV diastolic function.

Conclusions:

  • RV septal pacing is superior to RV apical pacing in preventing pacing-induced reductions in LV diastolic function in children with CHD.
  • Septal pacing should be considered to optimize diastolic function in pediatric patients requiring permanent ventricular pacing.

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