Abstract: | 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. |