PDF(Pubmed)
Abstract：
In congenitally corrected transposition of the great arteries (CCTGA) the right ventricle (RV) is systemic. Atrioventricular block (AVB) and systolic dysfunction are frequently observed. Permanent pacing of the subpulmonary left ventricle (LV) may worsen RV dysfunction. The aim of this study was to seek out if LV conduction system pacing (LVCSP) guided by three-dimensional-electroanatomic mapping systems (3D-EAMs) can preserve RV systolic function in paediatric CCTGA patients with AVB.
Retrospective analysis of CCTGA patients who underwent 3D-EAM-guided LVCSP. Three-dimensional-pacing map guided lead implantation towards septal sites with narrower paced QRS. Electrocardiograms (ECGs), echocardiograms, and lead parameters (threshold, sensing, and impedance) were compared at baseline (pre-implantation) and at 1-year follow-up. Right ventricle function was evaluated by 3D ejection fraction (EF), fractional area change (FAC), RV global longitudinal strain (GLS). Data are reported as median (25th-75th centiles). Seven CCTGA patients aged 15 (9-17) years, with complete/advanced AVB (4 with prior epicardial pacing), underwent 3D-guided LVCSP (5 DDD, 2 VVIR). Baseline echocardiographic parameters were impaired in most patients. No acute/chronic complications occurred. Ventricular pacing was >90%. At 1-year follow-up QRS duration showed no significant changes compared with baseline; however, QRS duration shortened in comparison with prior epicardial pacing. Lead parameters remained acceptable despite ventricular threshold increased. Systemic RV function was preserved: FAC and GLS improved significantly, and all patients showed normal RV EF (>45%).
Three-dimensional-EAM-guided LVCSP preserved RV systolic function in paediatric patients with CCTGA and AVB after short-term follow-up.
Retrospective analysis of CCTGA patients who underwent 3D-EAM-guided LVCSP. Three-dimensional-pacing map guided lead implantation towards septal sites with narrower paced QRS. Electrocardiograms (ECGs), echocardiograms, and lead parameters (threshold, sensing, and impedance) were compared at baseline (pre-implantation) and at 1-year follow-up. Right ventricle function was evaluated by 3D ejection fraction (EF), fractional area change (FAC), RV global longitudinal strain (GLS). Data are reported as median (25th-75th centiles). Seven CCTGA patients aged 15 (9-17) years, with complete/advanced AVB (4 with prior epicardial pacing), underwent 3D-guided LVCSP (5 DDD, 2 VVIR). Baseline echocardiographic parameters were impaired in most patients. No acute/chronic complications occurred. Ventricular pacing was >90%. At 1-year follow-up QRS duration showed no significant changes compared with baseline; however, QRS duration shortened in comparison with prior epicardial pacing. Lead parameters remained acceptable despite ventricular threshold increased. Systemic RV function was preserved: FAC and GLS improved significantly, and all patients showed normal RV EF (>45%).
Three-dimensional-EAM-guided LVCSP preserved RV systolic function in paediatric patients with CCTGA and AVB after short-term follow-up.
摘要：
目的：在先天性矫正的大动脉转位（CCTGA）中，右心室（RV）是全身性的。经常观察到房室传导阻滞（AVB）和收缩功能障碍。肺动脉下左心室（LV）的永久起搏可能会使RV功能障碍恶化。这项研究的目的是寻找在三维电解剖标测系统（3D-EAM）指导下的LV传导系统起搏（LVCSP）是否可以保留小儿CCTGAAVB患者的RV收缩功能。
结果：对接受3D-EAM引导的LVCSP的CCTGA患者进行回顾性分析。三维起搏图引导导联植入至间隔部位，QRS波起搏较窄。心电图(ECG),超声心动图,和导线参数(阈值，传感,和阻抗）在基线（植入前）和1年随访时进行比较。通过3D射血分数（EF）评估右心室功能，分数面积变化（FAC），RV全局纵向应变(GLS)。数据报告为中位数(25-75百分位数)。7名15岁（9-17岁）的CCTGA患者，完整/高级AVB（4例先前心外膜起搏），接受3D引导LVCSP(5DDD，2VVIR）。大多数患者的基线超声心动图参数受损。无急性/慢性并发症发生。心室起搏>90%。在1年随访时，QRS持续时间与基线相比无显著变化；然而，与先前的心外膜起搏相比，QRS持续时间缩短。尽管心室阈值增加，但导线参数仍可接受。系统性RV功能得到保留：FAC和GLS明显改善，所有患者的RVEF均正常（>45％）。
结论：三维EAM引导的LVCSP可在短期随访后保留儿童CCTGA和AVB患者的RV收缩功能。
结果：对接受3D-EAM引导的LVCSP的CCTGA患者进行回顾性分析。三维起搏图引导导联植入至间隔部位，QRS波起搏较窄。心电图(ECG),超声心动图,和导线参数(阈值，传感,和阻抗）在基线（植入前）和1年随访时进行比较。通过3D射血分数（EF）评估右心室功能，分数面积变化（FAC），RV全局纵向应变(GLS)。数据报告为中位数(25-75百分位数)。7名15岁（9-17岁）的CCTGA患者，完整/高级AVB（4例先前心外膜起搏），接受3D引导LVCSP(5DDD，2VVIR）。大多数患者的基线超声心动图参数受损。无急性/慢性并发症发生。心室起搏>90%。在1年随访时，QRS持续时间与基线相比无显著变化；然而，与先前的心外膜起搏相比，QRS持续时间缩短。尽管心室阈值增加，但导线参数仍可接受。系统性RV功能得到保留：FAC和GLS明显改善，所有患者的RVEF均正常（>45％）。
结论：三维EAM引导的LVCSP可在短期随访后保留儿童CCTGA和AVB患者的RV收缩功能。
