Chronic right ventricular pacing and ventricular function in patients with congenital complete atrioventricular block

Evaluation of: Kim JJ, Friedman RA, Eidem BW et al. Ventricular function and long-term pacing in children with congenital complete atrioventricular block. J. Cardiovasc. Electrophysiol. 18, 373–377 (2007).Cardiac pacing from right ventricular apex and free wall positions alters inter- and intraventricular impulse conduction and distorts biventricular contractility. In patients with congenital atrioventricular block there is a risk for heart failure, mitral regurgitation, syncope and sudden death before pacemaker implantation, and development of heart failure or mitral regurgitation after long-term ventricular pacing. Recently, selective site pacing has been recommended as a therapeutic option in patients with complete atrioventricular block. The evaluated study demonstrated that left ventricular dysfunction in patients with congenital complete atrioventricular block is rare, even in those who have been paced for more than 10 years. Right ventricular apex pacing and prolonged QRS duration may be associated with decreased ventricular function over time. At this time, with such a low incidence of cardiac dysfunction, right ventricular pacing should be considered an acceptable first-line therapy in this population.