CLINICAL STUDY: ELECTROPHYSIOLOGY
Left ventricular dysfunction after long-term right ventricular apical pacing in the young
M. Victoria T. Tantengco, MD, FAAC*,
Ronald L. Thomas, PhD and
Peter P. Karpawich, MD, FAAC*
* Division of Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
Children’s Research Center of Michigan, Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
Manuscript received September 29, 1999;
revised manuscript received February 26, 2001,
accepted March 14, 2001.
Reprint requests and correspondence: Dr. Tantengco, Pediatric Cardiology, 2nd Floor, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, Michigan 48201
mtanteng{at}dmc.org
OBJECTIVES
The goal of this study was to assess long-term global left ventricular (LV) function in patients paced from the right ventricular (RV) apex at a young age.
BACKGROUND
Ventricular contraction asynchrony with short-term RV apical pacing has been associated with reduced LV pump function and relaxation. The long-term effect of RV apical pacing on global LV function in the young remains unknown.
METHODS
Twenty-four patients with normal segmental anatomy paced from the RV apex (follow-up 1 to 19 years) underwent noninvasive assessment of global LV function with automated border detection echocardiography-derived fractional area of change (FAC), coupled with the Doppler index of myocardial performance (MPI). Data were analyzed from 24 RV-paced patients (mean follow-up 9.5 years, age 19 years, body surface area [BSA] 1.6 m2, QRS duration 140 ms) and compared with 33 age- and BSA-matched control subjects (age 16.4 years, BSA 1.6 m2). Multiple linear regression analysis was performed to identify patient variables that can affect these indexes of LV function.
RESULTS
Assessment of LV function (median follow-up 10 years) in 24 paced patients demonstrated impaired area- and Doppler flow-derived indexes of LV systolic and diastolic function, compared with those indexes of control subjects (FAC: 52% vs. 60%, p < 0.01; MPI: 0.46 vs. 0.34, p < 0.01). Paced QRS interval and age were found to significantly influence global LV contraction in these patients (R2 = 0.4, p < 0.05).
CONCLUSIONS
In the presence of impaired LV function with long-term RV apical pacing, alternative sites of ventricular pacing that simulate normal biventricular electrical activation should be explored to preserve function in pediatric patients in need of long-term pacing.
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Abbreviations and Acronyms
| | ABD | = (echocardiography-derived) automated border detection | | AV | = atrioventricular | | BSA | = body surface area | | +dP/dt | = maximal rate of rise of LV pressure | | FAC | = fractional area of change | | LV | = left ventricular or ventricle | | MPI | = (Doppler-derived) myocardial performance index | | RV | = right ventricular or ventricle |
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|
|
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|
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|
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|
|
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|
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|
|
|
|
|
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|
|
|
|
|
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H.-F. Tse and C.-P. Lau
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|
|
|
|
|
|
|
R. Lieberman, L. Padeletti, J. Schreuder, K. Jackson, A. Michelucci, A. Colella, W. Eastman, S. Valsecchi, and D. A. Hettrick
Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction
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October 17, 2006;
48(8):
1634 - 1641.
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|
|
|
|
|
|
|
M. H. Schoenfeld
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J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
1946 - 1948.
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[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and F. W. Prinzen
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J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
282 - 288.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Höijer, C. Meurling, and J. Brandt
Upgrade to biventricular pacing in patients with conventional pacemakers and heart failure: a double-blind, randomized crossover study.
Europace,
January 1, 2006;
8(1):
51 - 55.
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|
|
|
|
|
|
|
P. Dilaveris, A. Pantazis, G. Giannopoulos, A. Synetos, J. Gialafos, and C. Stefanadis
Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick?
Europace,
January 1, 2006;
8(5):
352 - 357.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Barber, A. S. Batra, G. H. Burch, I. Shen, R. M. Ungerleider, J. W. Brown, M. W. Turrentine, M. Mori, Y.-C. Hsieh, and S. Balaji
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46(10):
1937 - 1942.
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|
|
|
|
|
|
|
A. Dodge-Khatami, A. Kadner, H. Dave, M. Rahn, R. Pretre, and U. Bauersfeld
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Eur. J. Cardiothorac. Surg.,
October 1, 2005;
28(4):
541 - 545.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Y. Vanagt, X. A. Verbeek, T. Delhaas, M. Gewillig, L. Mertens, P. Wouters, B. Meyns, W. J. Daenen, and F. W. Prinzen
Acute Hemodynamic Benefit of Left Ventricular Apex Pacing in Children
Ann. Thorac. Surg.,
March 1, 2005;
79(3):
932 - 936.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Janousek, V. Tomek, V. Chaloupecky, O. Reich, R. A. Gebauer, J. Kautzner, and B. Hucin
Cardiac resynchronization therapy: A novel adjunct to the treatment and prevention of systemic right ventricular failure
J. Am. Coll. Cardiol.,
November 2, 2004;
44(9):
1927 - 1931.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. C. Hoppe
Beta-blocker induced bradycardia--should we pace?
Eur J Heart Fail,
June 1, 2004;
6(4):
449 - 451.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. N. Simantirakis, G. E. Kochiadakis, K. E. Vardakis, N. E. Igoumenidis, S. I. Chrysostomakis, and P. E. Vardas
Left Ventricular Mechanics and Myocardial Blood Flow Following Restoration of Normal Activation Sequence in Paced Patients With Long-term Right Ventricular Apical Stimulation
Chest,
July 1, 2003;
124(1):
233 - 241.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Peschar, H. de Swart, K. J. Michels, R. S. Reneman, and F. W. Prinzen
Left ventricular septal and apex pacing for optimal pump function in canine hearts
J. Am. Coll. Cardiol.,
April 2, 2003;
41(7):
1218 - 1226.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P. Redfearn, J. D. Hill, R. Keal, W. D. Toff, and P. J. Stafford
Left ventricular dysfunction resulting from frequent unifocal ventricular ectopics with resolution following radiofrequency ablation
Europace,
January 1, 2003;
5(3):
247 - 250.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Maurer, B. Naegeli, E. Straumann, O. Bertel, and J. Frielingsdorf
Quality of life and exercise capacity in patients with prolonged PQ interval and dual chamber pacemakers: a randomized comparison of permanent ventricular stimulation vs intrinsic AV conduction
Europace,
January 1, 2003;
5(4):
411 - 417.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Zhuang, Y. Zhang, K. A. Mowrey, J. Li, T. Tabata, D. W. Wallick, Z. B. Popovic, R. A. Grimm, A. Natale, and T. N. Mazgalev
Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation
Circulation,
October 1, 2002;
106(14):
1853 - 1858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
