title: Haemodynamic consequences of targeted single- and dual-site right ventricular pacing in adults with congenital heart disease undergoing surgical pulmonary valve replacement.
abstract: OBJECTIVE
  The purpose of this study was to create an epicardial electroanatomic map of the right ventricle (RV) and then apply post-operative-targeted single- and dual-site RV temporary pacing with measurement of haemodynamic parameters. Cardiac resynchronization therapy is an established treatment for symptomatic left ventricular (LV) dysfunction. In congenital heart disease, RV dysfunction is a common cause of morbidity-little is known regarding the potential benefits of CRT in this setting.
  
  
  RESULTS
  Sixteen adults (age = 32 ± 8 years; 6 M, 10 F) with right bundle branch block (RBBB) and repaired tetralogy of Fallot (n = 8) or corrected congenital pulmonary stenosis (n = 8) undergoing surgical pulmonary valve replacement (PVR) for pulmonary regurgitation underwent epicardial RV mapping and haemodynamic assessment of random pacing configurations including the site of latest RV activation. The pre-operative pulmonary regurgitant fraction was 49 ± 10%; mean LV end-diastolic volume (EDV) 85 ± 19 mL/min/m(2) and RVEDV 183 ± 89 mL/min/m(2) on cardiac magnetic resonance imaging. The mean pre-operative QRS duration is 136 ± 26 ms. The commonest site of latest activation was the RV free wall and DDD pacing here alone or combined with RV apical pacing resulted in significant increases in cardiac output (CO) vs. AAI pacing (P < 0.01 all measures). DDDRV alternative site pacing significantly improved CO by 16% vs. AAI (P = 0.018), and 8.5% vs. DDDRV apical pacing (P = 0.02).
  
  
  CONCLUSIONS
  Single-site RV pacing targeted to the region of latest activation in patients with RBBB undergoing PVR induces acute improvements in haemodynamics and supports the concept of 'RV CRT'. Targeted pacing in such patients has therapeutic potential both post-operatively and in the long term.
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Plymen
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Finlay
authors.affiliation: Department of Cardiovascular Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: O'leary
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Picaut
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Shay
authors.initials: S
authors.lastname: Cullen
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.affiliation: UCL Institute of Child Health, London, UK.
authors.forename: John E
authors.initials: JE
authors.lastname: Deanfield
authors.affiliation: Department of Cardiovascular Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: T Y
authors.initials: TY
authors.lastname: Hsia
authors.affiliation: East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK.
authors.forename: Aidan P
authors.initials: AP
authors.lastname: Bolger
authors.affiliation: Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK pier.lambiase@uclh.nhs.uk.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
mesh_terms: D000328:Adult; D002037:Bundle-Branch Block / Q000150:complications / Q000628:therapy*; D002302:Cardiac Output / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D056149:Epicardial Mapping; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000151:congenital / Q000601:surgery; D013318:Stroke Volume / Q000502:physiology; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery; D055815:Young Adult
keywords: Congenital heart disease; Electroanatomic map; Resynchronization; Right ventricle