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

  • Jan Janousek, Heart Center Leipzig, Germany
  • Roman Gebauer, Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany, Germany
  • Viktor Tomek, Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic, Czech Republic
  • Petr Kubus, Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic, Czech Republic
  • Vit Razek, Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany, Germany
  • Dr Roman Gebauer, Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic, Czech Republic
  • Tomas Matejka, Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic, Czech Republic
  • Martin Kostelka, Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany, Germany

    • Objective: Analysis of LV synchrony and function with respect to the epicardial pacing site in the young.
    Methods: LV synchrony (M-mode, speckle tracking) and function were evaluated in 32 young patients with complete non-surgical (N=15) or surgical (N=17) atrioventricular block (structural heart disease in 21/32) and permanent epicardial pacing from LV apex (N=19), RV apex (N=7) and RV free wall (N=6) (median age at implantation/duration of pacing: 5.5/22.8, 6.0/57.4 and 0.8/66.3 months, respectively).
    Results: LV synchrony and function differed significantly between the LV apical, RV apical and RV free wall pacing sites being worst in the latter: septal to posterior wall motion delay (SPWMD)= median 0, 69 and 136 ms (P<0.001), septal to lateral mechanical delay (SLMD)= 54±29, 73±24 and 129±70 ms (P=0.001), apical to basal mechanical delay (ABMD)= 96±37, 106±50 and 79±18 ms (P NS) and LV ejection fraction (EF)= 57±9, 49±12 and 33±10 % (P<0.001), respectively. LV EF correlated negatively with SPWMD (R2=0.454, P<0.001) and SLMD (R2=0.320, P<0.001) but not with ABMD. LV apical paced patients showed no correlation between duration of pacing and LV EF. Pacing site (P=0.014) and SPWMD (P=0.044), but not the duration of pacing, block etiology or presence of structural heart disease were significant multivariable predictors of LV EF.
    Conclusions: LV apical pacing preserves septal to lateral mechanical LV synchrony and systolic function and should be the preferred epicardial pacing site in young patients with systemic LV. (Supported by Research Project No 00064203 of University Hospital Motol, Prague, Czech Republic).