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Left ventricular function and right ventricular pacing for isolated congenital heart block

Di Salvo Giovanni; Issa, Ziad; Manea, Waleed; Bulbul, Ziad Al; Ahmadi, Mamdouh Al; Fayyadh, Majid Al
Journal of Cardiovascular Medicine: Post Author Corrections: May 07, 2013
doi: 10.2459/JCM.0b013e3283613836
Original article: PDF Only

Background

Right ventricular pacing has been the treatment of choice in patients with congenital complete atrioventricular block (CAVB). However, the effect of chronic right ventricular pacing on left ventricular function in young patients is still controversial.

Aim

The aim of the study was to assess the change in left ventricular systolic function in young patients (age ≤20 years) paced for isolated CAVB and to identify possible predictors of left ventricular systolic dysfunction.

Methods

We studied 55 young patients who underwent permanent right ventricular pacemaker implantation for CAVB in the absence of significant structural heart disease. We excluded patients affected by any condition known to affect left ventricular function. Echocardiographic data prior to and after pacemaker implantation were obtained.

Results

The mean age at the time of pacemaker implantation was 20 months, range 2.3–72 months. The mean duration of follow-up was 94.86 (range: 2–268 months). Chronic right ventricular pacing affected left ventricular shortening fraction (LVSF) significantly (pre = 37.8 ± 7.8 vs. post = 32.8 ± 5.5%, P = 0.0036). In 14 patients (25.4%), LVSF decreased by at least 7% (group A). The only parameter studied able to significantly discriminate the two groups was a better baseline LVSF in group A (baseline LVSF: 42.1 ± 5.2 vs. 32.2 ± 2.2%, P = 0.019; cut-off value >39%, P <0.0001; area under the curve = 0.887).

Conclusion

Chronic right ventricular pacing in young patients without significant structural heart disease is responsible for a significant reduction in left ventricular systolic function, especially in patients with a good baseline LVSF. These patients need close follow-up not only for pacing parameters but also for left ventricular functional evaluation.

Correspondence to Giovanni Di Salvo, MD, PhD, MMSc, FESC, King Faisal Specialist Hospital and Research Centre, MBC-16 PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia E-mail: giodisal@yahoo.it

Received 24 October, 2012

Revised 28 January, 2013

Accepted 10 March, 2013

© 2018 Italian Federation of Cardiology. All rights reserved.