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Europace Advance Access originally published online on November 6, 2009
Europace 2009 11(12):1654-1659; doi:10.1093/europace/eup342
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and CRT

Differential effects of the site of permanent epicardial pacing on left ventricular synchrony and function in the young: implications for lead placement

Roman A. Gebauer1,*, Viktor Tomek2, Petr Kubus2, Vít Rázek1, Tomás Matejka2, Aida Salameh1, Martin Kostelka3 and Jan Janousek1

1 Department of Pediatric Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany; 2 Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic; 3 Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany

Aims: To analyse left ventricular (LV) synchrony and function with respect to the epicardial pacing site in the young.

Methods and results: Left ventricular function and synchrony (M-mode, speckle tracking) were evaluated during mid-term follow-up in 32 children with complete non-surgical (n = 15) or surgical (n = 17) atrioventricular block (structural heart disease in 21/32) paced from LV apex (n = 19), right ventricular (RV) apex (n = 7), and RV free wall (n = 6), respectively. Data are in the following order: LV apical, RV apical, and RV free wall pacing. Septal to posterior wall motion delay (SPWMD) = median 0, 69, and 136 ms (P < 0.001), septal to lateral mechanical delay = 54 ± 29, 73 ± 24, and 129 ± 70 ms (P = 0.001), apical to basal mechanical delay = 96 ± 37, 106 ± 50, and 79 ± 18 ms (P NS), and LV ejection fraction (LVEF) = 57 ± 9, 49 ± 12, and 33 ± 10% (P < 0.001), respectively. Left ventricular ejection fraction correlated negatively with SPWMD (R2 = 0.454, P < 0.001) and septal to lateral mechanical delay (R2 = 0.320, P < 0.001) but not with apical to basal mechanical delay. Right ventricular free wall pacing (P = 0.014) and SPWMD (P = 0.044) were negative multivariable predictors of LVEF.

Conclusion: Compared with other sites, LV apical pacing preserves septal to lateral LV synchrony and systolic function and may be the preferred epicardial pacing site in the young.

Key Words: Permanent pacing, Heart block, Ventricular dysfunction, Left ventricular pacing, Right ventricular pacing, Children

* Corresponding author. Tel: +49 341 865 1036, Fax: +49 341 865 1143, Email: roman.gebauer{at}med.uni-leipzig.de

Manuscript submitted 26 August 2009. Accepted after revision 6 October 2009.


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