Diastolic function in paced children with cardiac defects: septum vs apex.
In children with structural congenital heart disease (CHD), the effects of chronic ventricular pacing on diastolic function are not well known. On the other hand, the beneficial effect of septal pacing over apical pacing is still controversial.The aim of this study was to evaluate the influence of different right ventricular (RV) pacing site on left ventricular (LV) diastolic function in children with cardiac defects.Twenty-nine pediatric patients with complete atrioventricular block (CAVB) and CHD undergoing permanent pacing were prospectively studied. Pacing sites were RV apex (n = 16) and RV septum (n = 13). Echocardiographic assessment was performed before pacemaker implantation and after it, during a mean follow‑up of 4.9 years.Compared to RV septum, transmitral E-wave was significantly affected in RV apical pacing (95.38 ± 9.19 vs 83 ± 18.75, p = 0.038). Likewise, parameters at the lateral annular tissue Doppler imaging (TDI) were significantly affected in children paced at the RV apex. The E´ wave correlated inversely with TDI lateral myocardial performance index (Tei index) (R2= 0.9849, p ≤ 0.001). RV apex pacing (Odds ratio, 0.648; confidence interval, 0.067-0.652; p = 0.003) and TDI lateral Tei index (Odds ratio, 31.21; confidence interval, 54.6-177.4; p = 0.025) predicted significantly decreased LV diastolic function.Of the two sites studied, RV septum prevents pacing-induced reduction of LV diastolic function.
Cardiocentro Pediatrico William Soler, La Habana, CU.
Michel Cabrera
MC
Ortega
Cardiocentro Pediatrico William Soler, La Habana, CU.
Adel Eladio
AE
Gonzalez Morejon
Cardiocentro Pediatrico William Soler, La Habana, CU.
Giselle Ricardo
GR
Serrano
Cardiocentro Pediatrico William Soler, La Habana, CU.
Dunia Barbara
DB
Benitez Ramos
D054537:Atrioventricular Block / Q000000981:diagnostic imaging / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000503:physiopathology*