Key result
Left ventricular epicardial pacing was associated with significantly more abnormal left ventricular systolic function compared to right ventricular septal pacing, as demonstrated by lower peak endocardial longitudinal strain (-13.8% vs -17.5%).
Why the study?
Chronic RV apical pacing in CCAVB causes LV dyssynchrony and dysfunction, motivating the evaluation of LV function with alternative pacing sites.
Does right ventricular septal pacing preserve left ventricular function better than left ventricular epicardial pacing as assessed by speckle tracking echocardiography in children with congenital complete atrioventricular block?
Cohort (n=72)
Single-blind
No
Does right ventricular septal pacing preserve left ventricular function better than left ventricular epicardial pacing as assessed by speckle tracking echocardiography in children with congenital complete atrioventricular block?
Absolute Event Rate: -13.8% vs -17.5%
p-value: p=0.03
In children with congenital complete atrioventricular block, speckle tracking echocardiography detects subtle left ventricular dysfunction better than conventional 2D echocardiography, revealing that right ventricular septal pacing preserves LV systolic function better than left ventricular epicardial pacing.
Right ventricular septal pacing may better preserve LV function than epicardial pacing in pediatric congenital AV block; leaves open need for randomized confirmation.
Background Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp). Methods This was a single center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle tracking echocardiography (STE). Results: We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, PLS Myo (-12.0 ± 3.3 vs. -18.1 ± 1.9, p < 0.001) and PLS endo (-16.1 ± 4.1 vs. -21.7 ± 1.7, p < 0.001). STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstated by lower values for PLS Myo (-10.1 ± 3.2 vs. -13.1 ± 2.9, p = 0.03) and PLS Endo (-13.8 ± 4.4 vs. -17.5 ± 3.3, p = 0.03 ) . Conclusions: LV dysfunction was better adjudicated by STE than 2D echocardiographic measurements (EF and SF) in our selected patients with CCAVB and permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals.
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Rivera et al. (2022) conducted a cohort in Congenital complete atrioventricular block (CCAVB) (n=72). Left ventricle epicardial pacing (LVEp) vs. Right ventricular septal pacing (RVSp) was evaluated on Peak endocardium longitudinal strain (PLS Endo) (p=0.03). Left ventricular epicardial pacing was associated with significantly more abnormal left ventricular systolic function compared to right ventricular septal pacing, as demonstrated by lower peak endocardial longitudinal strain (-13.8% vs -17.5%).
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