Predictors of left ventricular remodelling and failure in right ventricular pacing in the young
Open Access
- 12 March 2009
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 30 (9), 1097-1104
- https://doi.org/10.1093/eurheartj/ehp060
Abstract
To identify risk factors for left ventricular (LV) dysfunction in right ventricular (RV) pacing in the young. Left ventricular function was evaluated in 82 paediatric patients with either non-surgical (n = 41) or surgical (n= 41) complete atrioventricular block who have been 100% RV paced for a mean period of 7.4 years. Left ventricular shortening fraction (SF) decreased from a median (range) of 39 (24–62)% prior to implantation to 32 (8–49)% at last follow-up (P < 0.05). Prevalence of a combination of LV dilatation (LV end-diastolic diameter >+2z-values) and dysfunction (SF < 0.26) was found to increase from 1.3% prior to pacemaker implantation to 13.4% (11/82 patients) at last follow-up (P = 0.01). Ten of these 11 patients had progressive LV remodelling and 8 of 11 were symptomatic. The only significant risk factor for the development of LV dilatation and dysfunction was the presence of epicardial RV free wall pacing (OR = 14.3, P < 0.001). Other pre-implantation demographic, diagnostic, and haemodynamic factors including block aetiology, pacing variables, and pacing duration did not show independent significance. Right ventricular pacing leads to pathologic LV remodelling in a significant proportion of paediatric patients. The major independent risk factor is the presence of epicardial RV free wall pacing, which should be avoided whenever possible.This publication has 18 references indexed in Scilit:
- Ventricular Function and Long‐Term Pacing in Children with Congenital Complete Atrioventricular BlockJournal of Cardiovascular Electrophysiology, 2007
- Resynchronization Therapy in Pediatric and Congenital Heart Disease Patients: An International MultiCenter StudyJournal of the American College of Cardiology, 2005
- Acute Hemodynamic Benefit of Left Ventricular Apex Pacing in ChildrenThe Annals of Thoracic Surgery, 2005
- Detrimental Ventricular Remodeling in Patients With Congenital Complete Heart Block and Chronic Right Ventricular Apical PacingCirculation, 2004
- Initial experience with cardiac resynchronization therapy for ventricular dysfunction in young patients with surgically operated congenital heart diseaseThe American Journal of Cardiology, 2004
- The Left Ventricular Apex is the Optimal Site for Pediatric Pacing:Pacing and Clinical Electrophysiology, 2004
- Dilated Cardiomyopathy Associated with Dual-Chamber Pacing in Infants:. Improvement Through Either Left Ventricular Cardiac Resynchronization or Programming the Pacemaker Off Allowing Intrinsic Normal ConductionJournal of Cardiovascular Electrophysiology, 2004
- A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcomeJournal of the American College of Cardiology, 2003
- Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node DysfunctionCirculation, 2003
- Septal ventricular pacing in the immature canine heart: A new perspectiveAmerican Heart Journal, 1991