Pacemaker implantation as a risk factor for heart failure in young adults with congenital heart disease.
OBJECTIVE
Complete postoperative heart block following open-heart surgery and sinus node dysfunction are indications for permanent cardiac pacing in children with congenital heart defects. The purpose of our study was to evaluate if cardiac pacing is a risk factor of heart failure during longtime follow-up of grown ups with congenital heart disease (GUCH).


METHODS
For an objective assessment of heart failure, NT-Pro brain natriuretic peptide (BNP) and maximal oxygen uptake index (VO2max) during the cardiopulmonary exercise testing were measured in 346 consecutive GUCH patients during a longtime follow-up examination.


RESULTS
Thirty-nine of these patients who had pacemaker implantation had significantly increased BNP levels (448.2 +/- 76.8 vs 123.8 +/- 9.7 pg/mL, P < 0.0001) and significantly decreased VO(2max) (22.5 +/- 0.9 vs 27.4 +/- 0.4, P < 0.0001). Heart failure in pacemaker patients was associated with significantly prolonged QRS complex durations (171.1 +/- 8.3 ms vs 108.7 +/- 1.8 ms, P < 0.0001), increased right ventricular end diastolic diameters (38.7 +/- 2.1 mm vs 27.8 +/- 0.5mm, P < 0.0001), lower heart rates at rest (69.5 +/- 1.9/min vs 82 +/- 1/min, P < 0.0001), and at exercise (140.3 +/- 5.8/min vs 163.5 +/- 1.2/min, P < 0.0001). Mean fractional shortening of the left ventricle was normal in both patient groups.


CONCLUSIONS
Pacemaker implantation may be associated with heart failure during longtime follow-up of GUCH indicated by significantly elevated BNP levels and decreased VO2max. Possible explanations are prolongation of QRS complex duration, decreased maximal heart rates during exercise, and dilatation of the right ventricle.
Nothroff
Jörg
J
Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital Göttingen, Georg-August-University, Göttingen, Germany.
Norozi
Kambiz
K
Alpers
Valentin
V
Arnhold
Jan O
JO
Wessel
Armin
A
Ruschewski
Wolfgang
W
Buchhorn
Reiner
R
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000628:therapy*; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome