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Early results of AV sequential pacing on left ventricular outflow obstruction after Senning procedure
K Avasarala1, C Case, M Wienecke
1Cook Children's Medical Center, Fort Worth, Texas.
Insights
Atrioventricular sequential pacing from the left ventricular apex reduced left ventricular outflow tract obstruction by 45% in a patient with transposition of the great arteries after a Senning procedure. This pacing strategy may help manage obstruction and postpone surgery.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Left ventricular outflow tract (LVOT) obstruction is a known complication in patients with hypertrophic cardiomyopathy, historically managed with dual chamber pacing.
- The Senning procedure for transposition of the great arteries can lead to complex hemodynamics, including potential LVOT obstruction due to septal deviation and systolic anterior motion of the mitral valve.
Observation:
- A patient with TGA post-Senning procedure experienced LVOT obstruction and sinus node dysfunction.
- Atrioventricular (AV) sequential pacing was initiated from the left ventricular (LV) apex for bradycardia management.
- A short AV interval of 60 ms was utilized during pacing.
Findings:
- AV sequential pacing from the LV apex resulted in a significant 45% reduction in LVOT obstruction.
- Asynchronous septal contraction induced by pacing appears to be the mechanism for obstruction palliation.
- This approach was effective despite LV apical lead placement.
Implications:
- AV sequential pacing may serve as a palliative treatment for LVOT obstruction in post-Senning TGA patients.
- This pacing strategy could potentially help patients avoid or delay surgical intervention for LVOT obstruction.
- Further research is warranted to confirm the long-term efficacy and safety of this intervention.
Abstract:
Dual chamber pacing was shown to decrease left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy 30 years ago. We report early results of AV sequential pacing from the LV apex in a patient with transposition of the great arteries who is post-Senning procedure. LVOT obstruction resulted from septal deviation and systolic anterior motion of the mitral valve. Pacing was indicated for sinus node dysfunction. AV sequential pacing with a short optimal AV interval of 60 ms demonstrated a 45% reduction in the degree of LVOT obstruction. This article suggests that LVOT obstruction after the Senning procedure can be palliated by asynchronous septal contraction induced by AV sequential pacing, even if the activation is from LV apex, and avoid or postpone surgery in selected situations.
