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European Heart Journal Advance Access originally published online on March 12, 2009
European Heart Journal 2009 30(9):1097-1104; doi:10.1093/eurheartj/ehp060
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Predictors of left ventricular remodelling and failure in right ventricular pacing in the young

Roman A. Gebauer1, Viktor Tomek1, Aida Salameh2, Jan Marek3, Václav Chaloupecky1, Roman Gebauer1, Tomás Matejka1, Pavel Vojtovic1 and Jan Janousek2,*

1 Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic
2 Department of Pediatric Cardiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany
3 Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK

Received 11 May 2007; revised 11 December 2008; accepted 30 January 2009; online publish-ahead-of-print 12 March 2009.

* Corresponding author. Tel: +49 341 865 1036, Fax: +49 341 865 1143, Email: jan.janousek{at}medizin.uni-leipzig.de

See page 1033 for the editorial comment on this article (doi:10.1093/eurheartj/ehp130)

Aims: To identify risk factors for left ventricular (LV) dysfunction in right ventricular (RV) pacing in the young.

Methods and results: Left ventricular function was evaluated in 82 paediatric patients with either non-surgical (n = 41) or surgical (n= 41) complete atrioventricular block who have been 100% RV paced for a mean period of 7.4 years. Left ventricular shortening fraction (SF) decreased from a median (range) of 39 (24–62)% prior to implantation to 32 (8–49)% at last follow-up (P < 0.05). Prevalence of a combination of LV dilatation (LV end-diastolic diameter >+2z-values) and dysfunction (SF < 0.26) was found to increase from 1.3% prior to pacemaker implantation to 13.4% (11/82 patients) at last follow-up (P = 0.01). Ten of these 11 patients had progressive LV remodelling and 8 of 11 were symptomatic. The only significant risk factor for the development of LV dilatation and dysfunction was the presence of epicardial RV free wall pacing (OR = 14.3, P < 0.001). Other pre-implantation demographic, diagnostic, and haemodynamic factors including block aetiology, pacing variables, and pacing duration did not show independent significance.

Conclusion: Right ventricular pacing leads to pathologic LV remodelling in a significant proportion of paediatric patients. The major independent risk factor is the presence of epicardial RV free wall pacing, which should be avoided whenever possible.

Key Words: Permanent cardiac pacing • Heart failure • Cardiac resynchronization therapy • Congenital heart disease • Children


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