Why the study?
Does right ventricular septum pacing prevent the reduction of left ventricular diastolic function compared to right ventricular apex pacing in pediatric patients with complete atrioventricular block and congenital heart disease?
Does right ventricular septum pacing prevent the reduction of left ventricular diastolic function compared to right ventricular apex pacing in pediatric patients with complete atrioventricular block and congenital heart disease?
In pediatric patients with complete atrioventricular block and congenital heart disease, right ventricular septal pacing prevents pacing-induced reduction of left ventricular diastolic function compared to apical pacing.
RV septal pacing may better preserve LV diastolic function than apical pacing in pediatric AV block; hypothesis-generating and requires randomized confirmation before practice change.
In children with structural congenital heart disease (CHD), the effects of chronic ventricular pacing on diastolic function are not well known. On the other hand, the beneficial effect of septal pacing over apical pacing is still controversial.The aim of this study was to evaluate the influence of different right ventricular (RV) pacing site on left ventricular (LV) diastolic function in children with cardiac defects.Twenty-nine pediatric patients with complete atrioventricular block (CAVB) and CHD undergoing permanent pacing were prospectively studied. Pacing sites were RV apex (n = 16) and RV septum (n = 13). Echocardiographic assessment was performed before pacemaker implantation and after it, during a mean follow‑up of 4.9 years.Compared to RV septum, transmitral E-wave was significantly affected in RV apical pacing (95.38 ± 9.19 vs 83 ± 18.75, p = 0.038). Likewise, parameters at the lateral annular tissue Doppler imaging (TDI) were significantly affected in children paced at the RV apex. The E´ wave correlated inversely with TDI lateral myocardial performance index (Tei index) (R2= 0.9849, p ≤ 0.001). RV apex pacing (Odds ratio, 0.648; confidence interval, 0.067-0.652; p = 0.003) and TDI lateral Tei index (Odds ratio, 31.21; confidence interval, 54.6-177.4; p = 0.025) predicted significantly decreased LV diastolic function.Of the two sites studied, RV septum prevents pacing-induced reduction of LV diastolic function.
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Ortega et al. (2015) studied this question.
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