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Ventricular Functional Analysis in Congenital Complete Heart Block Using Speckle Tracking: Left Ventricular
Diana Milagros Torpoco Rivera1, Chenni Sriram2, Peter P Karpawich2
1Division of Cardiology, The Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, 3901 Beaubien, Boulevard, Detroit, MI, 48201, USA. dianatorpoco1202@gmail.com.
Insights
Speckle-tracking echocardiography (STE) revealed subtle left ventricular (LV) dysfunction in congenital complete atrioventricular block (CCAVB) patients with pacemakers. Transvenous right ventricular septal pacing better preserved LV systolic function than epicardial pacing.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Pacing
Background:
- Congenital complete atrioventricular block (CCAVB) often requires permanent pacing.
- Right ventricular (RV) apical pacing is linked to left ventricular (LV) dyssynchrony and dysfunction.
- Alternative pacing sites are explored to mitigate these adverse effects.
Purpose of the Study:
- To compare LV function between LV epicardial pacing (LVEp) and RV transvenous pacing (RVSp) in CCAVB patients.
- To assess LV function using speckle-tracking echocardiography (STE).
Main Methods:
- Retrospective, single-center study of CCAVB patients (≤18 years at implant).
- Comparison with age- and gender-matched healthy controls.
- Comprehensive LV function assessment using conventional 2D echocardiography and STE.
Main Results:
- Conventional echocardiography (SF, EF) showed normal LV function in pacemaker patients versus controls.
- STE detected abnormal LV myocardial and endocardial strain in pacemaker patients.
- STE revealed significantly better LV systolic function preservation with RVSp compared to LVEp.
Conclusions:
- STE is more sensitive than conventional echocardiography for detecting subtle LV dysfunction in CCAVB patients with pacemakers.
- Transvenous RV septal pacing is associated with superior LV systolic function preservation compared to LV epicardial pacing.
Background:
Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp).
Methods:
This was a single-center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as the control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle-tracking echocardiography (STE).
Results:
We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, Peak Longitudinal Strain myocardial (PLS Myo) [- 12.0 ± 3.3 vs. - 18.1 ± 1.9, p < 0.001] and Peak Longitudinal Strain endocardial (PLS endo) [- 16.1 ± 4.1 vs. 1.7 ± 1.7, p < 0.001]. STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstrated by lower values for PLS Myo (- 10.1 ± 3.2 vs. - 13.1 ± 2.9, p = 0.03) and PLS Endo (- 13.8 ± 4.4 vs. - 17.5 ± 3.3, p = 0.03).
Conclusion:
STE was more sensitive in detecting subtle differences in LV function relative to standard conventional 2D echocardiography (SF and EF) in selected patients with CCAVB and a permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals.
