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Adverse impact of chronic subpulmonary left ventricular pacing on systemic right ventricular function in patients with congenitally corrected transposition of the great arteries.
MedLine Citation:
PMID:  24374205     Owner:  NLM     Status:  Publisher    
BACKGROUND: Patients with congenitally corrected transposition of the great arteries (ccTGA) are at high risk of heart block requiring subpulmonary left ventricular (LV) pacing. Long-term right ventricular (RV) pacing in congenitally normal hearts is associated with LV dysfunction. We examined the effects of univentricular subpulmonary LV pacing on the systemic RV in a ccTGA cohort.
METHODS: ccTGA patients with two echocardiographic studies at least 6months apart were included. Records of 52 patients, 22 with pacing, were retrospectively reviewed. Seven patients with biventricular pacing were included for comparison.
RESULTS: The LV-Paced Group experienced deterioration in the RV fractional area change (RVFAC) (28.7±10.0 vs. 21.9±9.1%; P=0.003), systemic atrioventricular valve regurgitation (P=0.019) and RV dilatation (end-diastolic area 32.7±8.7 vs. 37.2±9.0cm(2); P=0.004). There was a corresponding deterioration in NYHA class (P=0.013). Multivariate Cox regression analysis showed that pacing was an independent predictor of deteriorating RV function and RV dilation (hazard ratio 2.7(10-7.0) and 4.7(1.1-20.6) respectively). None of these parameters changed significantly in the Un-paced Group. The CRT Group showed improvement in RVFAC (22.0% to 30.7% (P=0.030) and NYHA class (P=0.030), despite having lower baseline RVFAC (22.0±5.7 vs. 31±9.7%; P=0.025) and greater dyssynchrony (RV total isovolumic time 13.4±2.1 vs. 9.3±4.2s/min; P=0.016) when compared to the Un-Paced Group.
CONCLUSIONS: Univentricular subpulmonary LV pacing in patients with ccTGA predicted deterioration in RV function and RV dilatation over time associated with deteriorating NYHA class. Alternative primary pacing strategies such as biventricular pacing may need consideration in this vulnerable group already highly prone to mortality from systemic RV failure.
Wee Tiong Yeo; Julian W E Jarman; Wei Li; Michael A Gatzoulis; Tom Wong
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-7
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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