title: Chronic left ventricular pacing preserves left ventricular function in children.
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/2xLV 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.
authors.affiliation: Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, and Department of Pediatrics, University Hospital Maastricht, P.O. Box 616, NL-6200 MD, Maastricht, The Netherlands. i.vangeldorp@fys.unimaas.nl
authors.forename: Irene E
authors.initials: IE
authors.lastname: van Geldorp
authors.forename: Ward Y
authors.initials: WY
authors.lastname: Vanagt
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: Maren
authors.initials: M
authors.lastname: Tomaske
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
mesh_terms: D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial; D002648:Child; D002675:Child, Preschool; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy*; D016277:Ventricular Function, Left