Division of Cardiology, The Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, 3901 Beaubien, Boulevard, Detroit, MI, 48201, USA.
Pediatr Cardiol. 2023 Jun;44(5):1160-1167. doi: 10.1007/s00246-022-03093-7. Epub 2023 Jan 10.
Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp).
This was a single-center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as the control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle-tracking echocardiography (STE).
We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, Peak Longitudinal Strain myocardial (PLS Myo) [- 12.0 ± 3.3 vs. - 18.1 ± 1.9, p < 0.001] and Peak Longitudinal Strain endocardial (PLS endo) [- 16.1 ± 4.1 vs. 1.7 ± 1.7, p < 0.001]. STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstrated by lower values for PLS Myo (- 10.1 ± 3.2 vs. - 13.1 ± 2.9, p = 0.03) and PLS Endo (- 13.8 ± 4.4 vs. - 17.5 ± 3.3, p = 0.03).
STE was more sensitive in detecting subtle differences in LV function relative to standard conventional 2D echocardiography (SF and EF) in selected patients with CCAVB and a permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals.
患有先天性完全性房室传导阻滞（CCAVB）的患者进行慢性右心室（RV）心尖部起搏与左心室（LV）不同步和功能障碍有关。因此，提倡使用替代起搏部位。本研究的目的是比较 LV 功能，使用 STE 在选择的 LV 心外膜起搏（LVEp）与 RV 经静脉起搏（RVSp）的患者中进行比较。
这是一项在年龄≤18 岁的 CCAVB 患者中进行的单中心回顾性研究，这些患者接受了永久性起搏器植入。年龄和性别匹配的具有正常心脏解剖结构和功能的患者作为对照组。通过常规二维超声心动图和斑点追踪超声心动图（STE）全面评估 LV 功能。
我们纳入了 24 名起搏器组患者[9 名男性（27.6%），最后一次随访时的平均年龄为 17.1 岁，随访时间为 8.7 年，RVSp（n=9；62.5%）]，与 48 名匹配的健康对照组相比。短轴缩短分数（SF）和射血分数（EF）在病例组和对照组之间均正常且相似。然而，STE 在起搏器组中检测到 LV 功能异常。前者的心肌纵向应变峰值（PLS Myo）[-12.0±3.3 比 -18.1±1.9，p<0.001]和心内膜纵向应变峰值（PLS endo）[-16.1±4.1 比 1.7±1.7，p<0.001]较低/异常。与 RVSp 亚组相比，LVEp 组的 STE 检测到 LV 功能的参数明显更异常，表现为 PLS Myo 值较低（-10.1±3.2 比 -13.1±2.9，p=0.03）和 PLS Endo 值较低（-13.8±4.4 比 -17.5±3.3，p=0.03）。
与常规二维超声心动图（SF 和 EF）相比，STE 在检测 CCAVB 患者和永久性起搏器患者的 LV 功能方面更敏感。此外，STE 表明，与 LV 心外膜起搏相比，RV 间隔经静脉起搏在相当的植入后间隔内与更好的 LV 收缩功能保存相关。
