Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart
Ch Bharat Siddharth1, Jay Relan2
1Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Left ventricular (LV) pacing is superior to right ventricular (RV) pacing in children with heart block, preserving cardiac function and synchrony long-term. This finding is based on a review of the best available evidence in cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Electrophysiology
- Congenital Heart Disease
Background:
- Complete heart block in children often requires permanent pacing.
- The optimal pacing site (left vs. right ventricle) is debated.
- Understanding long-term effects on cardiac function is crucial.
Purpose of the Study:
- To determine if left ventricular (LV) pacing is superior to right ventricular (RV) pacing in pediatric patients with congenital or postoperative complete heart block.
- To synthesize the best available evidence regarding pacing site and its impact on cardiac function.
Main Methods:
- Systematic review of 19 papers identified through a structured protocol.
- Focus on 9 papers representing the best evidence.
- Tabulation of study characteristics, patient groups, outcomes, and results.
Main Results:
- Large multicenter studies indicate LV pacing is superior to RV pacing for left ventricular function.
- Multiple prospective and retrospective studies support LV pacing's superiority in preserving LV function.
- LV apex pacing may offer superior exercise tolerance compared to RV pacing.
Conclusions:
- Left ventricular pacing demonstrates superiority over right ventricular pacing regarding long-term cardiac function and ventricular synchrony.
- The LV apex is suggested as the optimal site for epicardial pacing.
- RV free wall pacing carries the highest risk of long-term LV dysfunction.
Abstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart block?' Altogether, 19 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two large multicentric showed that site of pacing was the major determinant of left ventricular (LV) function with LV pacing being superior to RV pacing, though the number of patients paced via LV was lesser in comparison to right ventricular (RV). There were 2 prospective, 2 retrospective and 1 cross-sectional studies with fewer patients that demonstrated superiority of LV over RV pacing in preserving LV function. Only 1 small-scale retrospective study showed similar results of LV and RV pacing on LV function. One cross-sectional study showed superiority of LV apical pacing on exercise tolerance. As per the existing literature, LV apex seems to be the most optimal site for epicardial pacing while RV free wall pacing has the highest risk of causing LV dysfunction over the long term. We conclude that LV pacing appears to be superior to RV pacing in terms of long-term effect on cardiac function and ventricular synchrony.
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