Predictors of left ventricular remodelling and failure in right ventricular pacing in the young

Eur Heart J. 2009 May;30(9):1097-104. doi: 10.1093/eurheartj/ehp060. Epub 2009 Mar 12.


Aims: To identify risk factors for left ventricular (LV) dysfunction in right ventricular (RV) pacing in the young. methods and results: Left ventricular function was evaluated in 82 paediatric patients with either non-surgical (n = 41) or surgical (n= 41) complete atrioventricular block who have been 100% RV paced for a mean period of 7.4 years. Left ventricular shortening fraction (SF) decreased from a median (range) of 39 (24-62)% prior to implantation to 32 (8-49)% at last follow-up (P < 0.05). Prevalence of a combination of LV dilatation (LV end-diastolic diameter >+2z-values) and dysfunction (SF < 0.26) was found to increase from 1.3% prior to pacemaker implantation to 13.4% (11/82 patients) at last follow-up (P = 0.01). Ten of these 11 patients had progressive LV remodelling and 8 of 11 were symptomatic. The only significant risk factor for the development of LV dilatation and dysfunction was the presence of epicardial RV free wall pacing (OR = 14.3, P < 0.001). Other pre-implantation demographic, diagnostic, and haemodynamic factors including block aetiology, pacing variables, and pacing duration did not show independent significance.

Conclusion: Right ventricular pacing leads to pathologic LV remodelling in a significant proportion of paediatric patients. The major independent risk factor is the presence of epicardial RV free wall pacing, which should be avoided whenever possible.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cardiac Pacing, Artificial / adverse effects*
  • Cardiac Pacing, Artificial / methods
  • Child
  • Child, Preschool
  • Diastole / physiology
  • Female
  • Heart Block / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Risk Assessment
  • Treatment Outcome
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Dysfunction, Left / surgery
  • Ventricular Remodeling / physiology*
  • Young Adult