Top

Published in:

Open Access 01-02-2009 | Original Article

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Authors: Irene E. van Geldorp, Ward Y. Vanagt, Urs Bauersfeld, Maren Tomaske, Frits W. Prinzen, Tammo Delhaas

Published in: Pediatric Cardiology | Issue 2/2009

Abstract

Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2 × LV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7% ± 6.0%) than in the LVP (32.2% ± 5.2%) or control (29.3% ± 4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8 ± 0.2) than in the LVP (1.4 ± 0.1) or control (1.4 ± 0.2) children. The SPWMD was significantly larger in the RVP (338 ± 20 ms) than in the LVP (−16 ± 14 ms) or control (−5 ± 35 ms) group, whereas QRS duration was similarly longer in the RVP (157 ± 10 ms) and LVP (158 ± 22 ms) groups compared than in the control group (69 ± 7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.

Andersen HR, Nielsen JC, Thomsen PE et al (1997) Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 350:1210–1216PubMedCrossRef

Arts T, Bovendeerd PH, Prinzen FW, Reneman RS (1991) Relation between left ventricular cavity pressure and volume and systolic fiber stress and strain in the wall. Biophys J 59:93–102PubMedCrossRef

Blanc JJ, Etienne Y, Gilard M et al (1997) Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation 96:3273–3277PubMed

Blanc JJ, Bertault-Valls V, Fatemi M et al (2004) Midterm benefits of left univentricular pacing in patients with congestive heart failure. Circulation 109:1741–1744PubMedCrossRef

Daubeney PE, Blackstone EH, Weintraub RG et al (1999) Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Cardiol Young 9:402–410PubMedCrossRef

de Cock CC, Giudici MC, Twisk JW (2003) Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: a quantitative review. Europace 5:275–278PubMedCrossRef

Delhaas T, Arts T, Bovendeerd PH et al (1993) Subepicardial fiber strain and stress as related to left ventricular pressure and volume. Am J Physiol 264:H1548–H1559PubMed

Deshmukh P, Casavant DA, Romanyshyn M, Anderson K (2000) Permanent, direct his-bundle pacing: a novel approach to cardiac pacing in patients with normal his-purkinje activation. Circulation 101:869–877PubMed

Dodge-Khatami A, Kadner A, Dave H et al (2005) Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approach with excellent functional and cosmetic results. Eur J Cardiothorac Surg 28:541–545PubMedCrossRef

10.

Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known: 1916. Nutrition 5:303–311; (discussion 312–303)PubMed

11.

Dubin AM, Janousek J, Rhee E et al (2005) Resynchronization therapy in pediatric and congenital heart disease patients: an international multicenter study. J Am Coll Cardiol 46:2277–2283PubMedCrossRef

12.

Etienne Y, Mansourati J, Gilard M et al (1999) Evaluation of left ventricular-based pacing in patients with congestive heart failure and atrial fibrillation. Am J Cardiol 83:1138–1140, A1139PubMedCrossRef

13.

Janousek J, Vojtovic P, Hucin B et al (2001) Resynchronization pacing is a useful adjunct to the management of acute heart failure after surgery for congenital heart defects. Am J Cardiol 88:145–152PubMedCrossRef

14.

Karpawich PP, Mital S (1997) Comparative left ventricular function following atrial, septal, and apical single chamber heart pacing in the young. Pacing Clin Electrophysiol 20:1983–1988PubMedCrossRef

15.

Karpawich PP, Rabah R, Haas JE (1999) Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. Pacing Clin Electrophysiol 22:1372–1377PubMedCrossRef

16.

Karpawich PP (2004) Chronic right ventricular pacing and cardiac performance: the pediatric perspective. Pacing Clin Electrophysiol 27:844–849PubMedCrossRef

17.

Kim JJ, Friedman RA, Eidem BW et al (2007) Ventricular function and long-term pacing in children with congenital complete atrioventricular block. J Cardiovasc Electrophysiol 18:373–377PubMedCrossRef

18.

Lumens J, Delhaas T, Kirn B, Arts T (2008) Modeling ventricular interaction: a multiscale approach from sarcomere mechanics to cardiovascular system hemodynamics. Pac Symp Biocomput 13:378–389

19.

Manolis AS (2006) The deleterious consequences of right ventricular apical pacing: time to seek alternate site pacing. Pacing Clin Electrophysiol 29:298–315PubMedCrossRef

20.

Moak JP, Hasbani K, Ramwell C et al (2006) Dilated cardiomyopathy following right ventricular pacing for AV block in young patients: resolution after upgrading to biventricular pacing systems. J Cardiovasc Electrophysiol 17:1068–1071PubMedCrossRef

21.

Nelson GS, Berger RD, Fetics BJ et al (2000) Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 102:3053–3059PubMed

22.

Peschar M, de Swart H, Michels KJ et al (2003) Left ventricular septal and apex pacing for optimal pump function in canine hearts. J Am Coll Cardiol 41:1218–1226PubMedCrossRef

23.

Pitzalis MV, Iacoviello M, Romito R et al (2002) Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 40:1615–1622PubMedCrossRef

24.

Pitzalis MV, Iacoviello M, Romito R et al (2005) Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy. J Am Coll Cardiol 45:65–69PubMedCrossRef

25.

Prinzen FW, Van Oosterhout MF, Vanagt WY et al (1998) Optimization of ventricular function by improving the activation sequence during ventricular pacing. Pacing Clin Electrophysiol 21:2256–2260PubMedCrossRef

26.

Prinzen FW, Peschar M (2002) Relation between the pacing induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol 25:484–498PubMedCrossRef

27.

Puggioni E, Brignole M, Gammage M et al (2004) Acute comparative effect of right and left ventricular pacing in patients with permanent atrial fibrillation. J Am Coll Cardiol 43:234–238PubMedCrossRef

28.

Sweeney MO, Hellkamp AS, Ellenbogen KA et al (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107:2932–2937PubMedCrossRef

29.

Takasugi H, Watanabe K, Ono Y, Echigo S (2005) Improvement of left ventricular function after changing the pacing site in a child with isolated congenital complete atrioventricular block and dilated cardiomyopathy. Pediatr Cardiol 26:87–89PubMedCrossRef

30.

Tantengco MV, Thomas RL, Karpawich PP (2001) Left ventricular dysfunction after long-term right ventricular apical pacing in the young. J Am Coll Cardiol 37:2093–2100PubMedCrossRef

31.

Thambo JB, Bordachar P, Garrigue S et al (2004) Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 110:3766–3772PubMedCrossRef

32.

Tissot C, Aggoun Y, Rimensberger PC et al (2007) Left ventricular epicardial VVI pacing for a congenital complete heart block with severe myocardial dysfunction: shall epicardial pacing wires be positioned left? Int J Cardiol 116:e7–e9PubMedCrossRef

33.

Touiza A, Etienne Y, Gilard M et al (2001) Long-term left ventricular pacing: assessment and comparison with biventricular pacing in patients with severe congestive heart failure. J Am Coll Cardiol 38:1966–1970PubMedCrossRef

34.

Van Bogart JWC (1996) What can go wrong with magnetic media? Pub Res Q 12:65–77CrossRef

35.

van Oosterhout MF, Prinzen FW, Arts T et al (1998) Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall. Circulation 98:588–595PubMed

36.

Vanagt WY, Verbeek XA, Delhaas T et al (2004) The left ventricular apex is the optimal site for pediatric pacing. Pacing Clin Electrophysiol 27:837–843PubMedCrossRef

37.

Vanagt WY, Prinzen FW, Delhaas T (2007) Reversal of pacing-induced heart failure by left ventricular apical pacing. N Engl J Med 357:2637–2638PubMedCrossRef

38.

Vatasescu R, Shalganov T, Paprika D et al (2007) Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated congenital heart block: a medium term follow-up. Europace 9:228–232PubMedCrossRef

39.

Verbeek XA, Vernooy K, Peschar M et al (2003) Intraventricular resynchronization for optimal left ventricular function during pacing in experimental left bundle branch block. J Am Coll Cardiol 42:558–567PubMedCrossRef

40.

Vernooy K, Verbeek XA, Peschar M et al (2005) Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J 26:91–98PubMedCrossRef

41.

Vernooy K, Cornelussen RNM, Verbeek XAAM et al (2007) Cardiac resynchronization therapy cures dyssynchronopathy in canine left bundle-branch block hearts. Eur Heart J 28:2148–2155PubMedCrossRef

42.

Zimmerman FJ, Starr JP, Koenig PR et al (2003) Acute hemodynamic benefit of multisite ventricular pacing after congenital heart surgery. Ann Thorac Surg 75:1775–1780PubMedCrossRef

Title: Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children
Authors: Irene E. van Geldorp
Ward Y. Vanagt
Urs Bauersfeld
Maren Tomaske
Frits W. Prinzen
Tammo Delhaas
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: Pediatric Cardiology / Issue 2/2009
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-008-9284-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2009

Prenatal Diagnosis and Management of Fetal Long QT Syndrome

Upcoming Events in Pediatric Cardiology

Effect of Open Heart Surgery with Cardiopulmonary Bypass on Peripheral Blood Lymphocyte Apoptosis in Children

Takotsubo-Like Cardiomyopathy in a 17-Year-Old Male with a Pheochromocytoma

Philosopher, Pediatrician, Pathologist? John Locke’s Thoughts on Rhicketts and a Missed Case of Ebstein’s Anomaly

From Other Journals