title: Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey.
abstract: BACKGROUND
  Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function.
  
  
  OBJECTIVE
  In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated.
  
  
  METHODS
  Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics.
  
  
  RESULTS
  From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients.
  
  
  CONCLUSIONS
  In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, PO Box 616, Maastricht NL-6200, The Netherlands. i.vangeldorp@maastrichtuniversity.nl
authors.forename: Irene E
authors.initials: IE
authors.lastname: van Geldorp
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.forename: Roman A
authors.initials: RA
authors.lastname: Gebauer
authors.forename: Patrick
authors.initials: P
authors.lastname: Frias
authors.forename: Maren
authors.initials: M
authors.lastname: Tomaske
authors.forename: Mark K
authors.initials: MK
authors.lastname: Friedberg
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Tisma-Dupanovic
authors.forename: Jan
authors.initials: J
authors.lastname: Elders
authors.forename: Andreas
authors.initials: A
authors.lastname: Früh
authors.forename: Fulvio
authors.initials: F
authors.lastname: Gabbarini
authors.forename: Petr
authors.initials: P
authors.lastname: Kubus
authors.forename: Viera
authors.initials: V
authors.lastname: Illikova
authors.forename: Sabrina
authors.initials: S
authors.lastname: Tsao
authors.forename: Andreas Christian
authors.initials: AC
authors.lastname: Blank
authors.forename: Anita
authors.initials: A
authors.lastname: Hiippala
authors.forename: Thierry
authors.initials: T
authors.lastname: Sluysmans
authors.forename: Peter
authors.initials: P
authors.lastname: Karpawich
authors.forename: Sally-Ann
authors.initials: SA
authors.lastname: Clur
authors.forename: Xavier
authors.initials: X
authors.lastname: Ganame
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Collins
authors.forename: Gisela
authors.initials: G
authors.lastname: Dann
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
authors.forename: Conceição
authors.initials: C
authors.lastname: Trigo
authors.forename: Bert
authors.initials: B
authors.lastname: Nagel
authors.forename: John
authors.initials: J
authors.lastname: Papagiannis
authors.forename: Annette
authors.initials: A
authors.lastname: Rackowitz
authors.forename: Jan
authors.initials: J
authors.lastname: Marek
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Nürnberg
authors.forename: Ward Y
authors.initials: WY
authors.lastname: Vanagt
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Jan
authors.initials: J
authors.lastname: Janousek
mesh_terms: D000293:Adolescent; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000517:prevention & control; D016277:Ventricular Function, Left / Q000502:physiology*