Abstract
BACKGROUND-: Right ventricular pacing increases the risk of heart failure in adults with structural heart disease. The impact of prolonged right ventricular pacing in adults without structural heart disease is not fully characterized and may depend on interactions of pacing with abnormal substrate predisposing to ventricular dysfunction. METHODS AND RESULTS-: We assessed the effect of right ventricular pacing in patients who underwent pacemaker implantation for isolated congenital atrioventricular block between 1964 and 2005. To assess for immunologic contribution to cardiac dysfunction, outcomes were compared between patients with (Ab) and without (Ab) antinuclear antibody during adulthood and an age-and sex-matched Olmsted County, Minnesota, population. Of 103 patients (mean±SD age, 32±19 years), 18 were Ab. Long-term survival free of new heart failure after pacemaker implantation in isolated congenital atrioventricular block patients was worse than in the matched population (P<0.001). This difference was attributable to the development of heart failure in 12 Ab patients (67%; P<0.001), without differences between Ab patients (2%) and the matched population (2%; P=0.7). Compared with baseline, at last follow-up, left ventricular ejection fraction did not decline in Ab (53±9% to 57±12%) but decreased in Ab(52±10% to 38±12%; P=0.03) patients. Survival was similar in Ab patients and the Minnesota population (98%; P=0.7) but worse in Ab patients (79%; P<0.01). CONCLUSIONS-: The natural history of patients with isolated congenital atrioventricular block who require pacing depends upon their antibody status. Antinuclear antibody status was a predictor for the development of heart failure and death. Long-term right ventricular pacing alone does not appear to be associated with development of heart failure, deterioration in ventricular function, or reduced survival in Ab isolated congenital atrioventricular block patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1698-1705 |
| Number of pages | 8 |
| Journal | Circulation |
| Volume | 121 |
| Issue number | 15 |
| DOIs | |
| State | Published - Apr 2010 |
Fingerprint
Keywords
- Antibodies
- Artificial
- Atrioventricular block
- Cardiac pacing
- Congenital
- Death
- Follow-up studies
- Heart defects
- Heart failure
ASJC Scopus subject areas
- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Cite this
Effect of long-term right ventricular pacing in young adults with structurally normal heart. / Sagar, Sandeep; Shen, Win Kuang; Asirvatham, Samuel J; Cha, Yong-Mei; Espinosa, Raul Emilio; Friedman, Paul Andrew; Hodge, David O.; Munger, Thomas M.; Porter, Co Burn J; Rea, Robert F.; Hayes, David L.; Jahangir, Arshad.
In: Circulation, Vol. 121, No. 15, 04.2010, p. 1698-1705.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of long-term right ventricular pacing in young adults with structurally normal heart
AU - Sagar, Sandeep
AU - Shen, Win Kuang
AU - Asirvatham, Samuel J
AU - Cha, Yong-Mei
AU - Espinosa, Raul Emilio
AU - Friedman, Paul Andrew
AU - Hodge, David O.
AU - Munger, Thomas M.
AU - Porter, Co Burn J
AU - Rea, Robert F.
AU - Hayes, David L.
AU - Jahangir, Arshad
PY - 2010/4
Y1 - 2010/4
N2 - BACKGROUND-: Right ventricular pacing increases the risk of heart failure in adults with structural heart disease. The impact of prolonged right ventricular pacing in adults without structural heart disease is not fully characterized and may depend on interactions of pacing with abnormal substrate predisposing to ventricular dysfunction. METHODS AND RESULTS-: We assessed the effect of right ventricular pacing in patients who underwent pacemaker implantation for isolated congenital atrioventricular block between 1964 and 2005. To assess for immunologic contribution to cardiac dysfunction, outcomes were compared between patients with (Ab) and without (Ab) antinuclear antibody during adulthood and an age-and sex-matched Olmsted County, Minnesota, population. Of 103 patients (mean±SD age, 32±19 years), 18 were Ab. Long-term survival free of new heart failure after pacemaker implantation in isolated congenital atrioventricular block patients was worse than in the matched population (P<0.001). This difference was attributable to the development of heart failure in 12 Ab patients (67%; P<0.001), without differences between Ab patients (2%) and the matched population (2%; P=0.7). Compared with baseline, at last follow-up, left ventricular ejection fraction did not decline in Ab (53±9% to 57±12%) but decreased in Ab(52±10% to 38±12%; P=0.03) patients. Survival was similar in Ab patients and the Minnesota population (98%; P=0.7) but worse in Ab patients (79%; P<0.01). CONCLUSIONS-: The natural history of patients with isolated congenital atrioventricular block who require pacing depends upon their antibody status. Antinuclear antibody status was a predictor for the development of heart failure and death. Long-term right ventricular pacing alone does not appear to be associated with development of heart failure, deterioration in ventricular function, or reduced survival in Ab isolated congenital atrioventricular block patients.
AB - BACKGROUND-: Right ventricular pacing increases the risk of heart failure in adults with structural heart disease. The impact of prolonged right ventricular pacing in adults without structural heart disease is not fully characterized and may depend on interactions of pacing with abnormal substrate predisposing to ventricular dysfunction. METHODS AND RESULTS-: We assessed the effect of right ventricular pacing in patients who underwent pacemaker implantation for isolated congenital atrioventricular block between 1964 and 2005. To assess for immunologic contribution to cardiac dysfunction, outcomes were compared between patients with (Ab) and without (Ab) antinuclear antibody during adulthood and an age-and sex-matched Olmsted County, Minnesota, population. Of 103 patients (mean±SD age, 32±19 years), 18 were Ab. Long-term survival free of new heart failure after pacemaker implantation in isolated congenital atrioventricular block patients was worse than in the matched population (P<0.001). This difference was attributable to the development of heart failure in 12 Ab patients (67%; P<0.001), without differences between Ab patients (2%) and the matched population (2%; P=0.7). Compared with baseline, at last follow-up, left ventricular ejection fraction did not decline in Ab (53±9% to 57±12%) but decreased in Ab(52±10% to 38±12%; P=0.03) patients. Survival was similar in Ab patients and the Minnesota population (98%; P=0.7) but worse in Ab patients (79%; P<0.01). CONCLUSIONS-: The natural history of patients with isolated congenital atrioventricular block who require pacing depends upon their antibody status. Antinuclear antibody status was a predictor for the development of heart failure and death. Long-term right ventricular pacing alone does not appear to be associated with development of heart failure, deterioration in ventricular function, or reduced survival in Ab isolated congenital atrioventricular block patients.
KW - Antibodies
KW - Artificial
KW - Atrioventricular block
KW - Cardiac pacing
KW - Congenital
KW - Death
KW - Follow-up studies
KW - Heart defects
KW - Heart failure
UR - http://www.scopus.com/inward/record.url?scp=77951429781&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951429781&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.109.866343
DO - 10.1161/CIRCULATIONAHA.109.866343
M3 - Article
C2 - 20368525
AN - SCOPUS:77951429781
VL - 121
SP - 1698
EP - 1705
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 15
ER -