Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Cardiac Surgery Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Pacing Clin Electrophysiol. 2020 Jun;43(6):535-541. doi: 10.1111/pace.13908. Epub 2020 Apr 22.
Small retrospective studies reported that left ventricular (LV) pacing is likely to preserve LV function in children with isolated congenital complete atrioventricular block (CCAVB). The aim of this study was to prospectively evaluate LV contractility and synchrony in a cohort of neonates/infants at pacemaker implantation and follow-up.
Patients with CCAVB who underwent LV pacing were evaluated with electrocardiogram and echocardiogram in a single-center, prospective study. Data were collected at implantation, at 1-month and every year of follow-up, up to 5 years. LV ventricular dimensions (diameters and volumes), systolic function (ejection fraction [EF] and global longitudinal strain [GLS]), and synchrony were evaluated. Data are reported as median (25th-75th centiles).
Twenty consecutive patients with CCAVB underwent pacemaker implantation (12 single-chamber pacemaker [VVIR] and eight dual-chamber pacemaker [DDD]) with epicardial leads: 17 on the LV apex and three on the free wall. Age at implantation was 0.3 months (1 day-4.5 months). Patients showed good clinical status, normal LV dimensions, preserved systolic function, and synchrony at 60 (30-60) months follow-up. EF increased to normal values in patients with preimplantation EF <50%. Presence of antibodies and pacing mode (DDD vs VVIR) had no impact on the outcome.
LV pacing preserved LV systolic function and synchrony in neonates and infants with CCAVB at 5-year follow-up. LV EF improved in patients with low preimplantation EF. Pacing mode or the presence of autoantibodies did not demonstrated an impact on LV contractility and synchrony.
一些小型回顾性研究报告称，左心室（LV）起搏可能有助于保留孤立性先天性完全性房室传导阻滞（CCAVB）患儿的 LV 功能。本研究旨在前瞻性评估一组在起搏器植入和随访时的新生儿/婴儿的 LV 收缩性和同步性。
在一项单中心前瞻性研究中，对接受 LV 起搏的 CCAVB 患者进行心电图和超声心动图评估。在植入时、植入后 1 个月和每年随访时（最长 5 年）收集数据。评估 LV 心室尺寸（直径和容量）、收缩功能（射血分数 [EF] 和整体纵向应变 [GLS]）和同步性。数据以中位数（25-75 百分位数）报告。
20 例 CCAVB 患者接受了起搏器植入（12 例单腔起搏器[VVIR]和 8 例双腔起搏器[DDD]），使用心外膜导联：17 例在 LV 心尖部，3 例在游离壁。植入时年龄为 0.3 个月（1 天-4.5 个月）。患者在 60（30-60）个月随访时表现出良好的临床状态、正常的 LV 尺寸、保留的收缩功能和同步性。植入前 EF<50%的患者 EF 增加至正常。存在抗体和起搏模式（DDD 与 VVIR）对结果没有影响。
LV 起搏在 5 年随访时保留了 CCAVB 新生儿和婴儿的 LV 收缩功能和同步性。植入前 EF 较低的患者 EF 得到改善。起搏模式或自身抗体的存在并未显示对 LV 收缩性和同步性有影响。
