Ortega Michel Cabrera, Gonzalez Morejon Adel Eladio, Serrano Giselle Ricardo, Benitez Ramos Dunia Barbara
Cardiocentro Pediatrico William Soler, La Habana, CU.
Arq Bras Cardiol. 2015 Aug;105(2):184-7. doi: 10.5935/abc.20150077.
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.
在患有结构性先天性心脏病（CHD）的儿童中，慢性心室起搏对舒张功能的影响尚不清楚。另一方面，间隔起搏相对于心尖起搏的有益效果仍存在争议。本研究的目的是评估不同右心室（RV）起搏部位对患有心脏缺陷儿童左心室（LV）舒张功能的影响。对29例患有完全性房室传导阻滞（CAVB）且接受永久性起搏的CHD儿科患者进行了前瞻性研究。起搏部位为右心室心尖（n = 16）和右心室间隔（n = 13）。在起搏器植入前和植入后进行超声心动图评估，平均随访4.9年。与右心室间隔相比，右心室心尖起搏时二尖瓣E波受到显著影响（95.38±9.19对83±18.75，p = 0.038）。同样，在右心室心尖起搏的儿童中，外侧环组织多普勒成像（TDI）参数也受到显著影响。E´波与TDI外侧心肌性能指数（Tei指数）呈负相关（R2 = 0.9849，p≤0.001）。右心室心尖起搏（优势比，0.648；置信区间，0.067 - 0.652；p = 0.003）和TDI外侧Tei指数（优势比，31.21；置信区间，54.6 - 177.4；p = 0.025）显著预测左心室舒张功能降低。在所研究的两个部位中，右心室间隔可防止起搏引起的左心室舒张功能降低。
