Key result
Chronic RV apical pacing in children after TOF repair was associated with preservation of RV systolic function (TAPSE correlation with duration r=0.724; P<0.001) and prevented QRS prolongation.
Why the study?
The midterm effect of chronic apical right ventricular pacing on right and left ventricular function following tetralogy of Fallot repair required evaluation using multiple echocardiographic modalities.
Does chronic apical right ventricular pacing preserve ventricular function in children after tetralogy of Fallot repair?
Case-Control (n=49)
Does chronic apical right ventricular pacing preserve ventricular function in children after tetralogy of Fallot repair?
Chronic RV apical pacing in children after TOF repair is associated with preservation of RV systolic function and prevention of progressive QRS prolongation without deteriorating LV systolic function.
May support apical RV pacing to preserve function post-TOF repair in children; hypothesis-generating and needs prospective validation before practice change.
OBJECTIVE: We aim to evaluate the midterm effect of chronic apical right ventricular (RV) pacing on right and left ventricular (LV) function using different modalities of echocardiography including conventional echocardiography, tissue Doppler imaging and two-dimension speckle tracking echocardiography. METHODS: This case-control study enrolled 49 patients divided into two groups: a paced group and a nonpaced group. The paced group included 23 patients that underwent tetralogy of Fallot (TOF) repair and required permanent pacemaker insertion for postoperative complete heart block. The nonpaced group included 26 patients that had TOF repair at the same period. RESULTS: The median age for the paced and nonpaced groups was 6 and 8 years, respectively (P = .169). The follow-up duration after TOF surgical repair was 4 years for the paced patients and 5 years for nonpaced patients (P = .411). In the nonpaced group, the QRS duration increased and LV global longitudinal strain (GLS) decreased significantly with increasing duration after TOF repair, P value was .006 and .042, respectively. In the paced group, tricuspid annular systolic plane excursion (TAPSE) was significantly correlated with age (r = .578; P = .004) and duration following TOF correction (r = .724; P < .001). CONCLUSION: Chronic RV apical pacing in children after TOF repair was associated with better clinical status, preservation of RV systolic function, and prevention of progressive QRS prolongation. RV pacing was not associated with progressive deterioration of LV systolic function with increasing the time interval following TOF repair. Therefore, RV pacing can be beneficial in corrected TOF patients presenting with RV failure.
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El‐Shabrawi et al. (2020) conducted a case-control in Tetralogy of Fallot (TOF) post-repair (n=49). Chronic apical right ventricular (RV) pacing vs. No pacing was evaluated on Right and left ventricular function evaluated via echocardiography. Chronic RV apical pacing in children after TOF repair was associated with preservation of RV systolic function (TAPSE correlation with duration r=0.724; P<0.001) and prevented QRS prolongation.
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