Left ventricular epicardial pacing preserved left ventricular ejection fraction compared to right ventricular apical pacing (69% vs 64%, p<0.001) in pediatric patients with complete atrioventricular block.
Cohort (n=80)
Single-blind
No
Does left ventricular epicardial pacing preserve left ventricular synchrony and function compared to right ventricular endocardial pacing in pediatric patients with complete atrioventricular block?
Left ventricular epicardial pacing preserves cardiac synchrony and systolic function better than right ventricular endocardial pacing in pediatric patients with complete AV block.
Tasa de eventos absoluta: 69% vs 64%
valor p: p=<0.001
BACKGROUND: Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern,producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. OBJECTIVE: The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). METHODS: LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. RESULTS: LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). CONCLUSION: Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function.
Ortega et al. (Tue,) conducted a cohort in Complete atrioventricular block (n=80). Left ventricular epicardial pacing vs. Right ventricular apical pacing was evaluated on Left ventricular ejection fraction at final follow-up (p=<0.001). Left ventricular epicardial pacing preserved left ventricular ejection fraction compared to right ventricular apical pacing (69% vs 64%, p<0.001) in pediatric patients with complete atrioventricular block.