Effect of long-term right ventricular pacing in young adults with structurally normal heart

Sandeep Sagar, Win Kuang Shen, Samuel J Asirvatham, Yong-Mei Cha, Raul Emilio Espinosa, Paul Andrew Friedman, David O. Hodge, Thomas M. Munger, Co Burn J Porter, Robert F. Rea, David L. Hayes, Arshad Jahangir

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)1698-1705
Number of pages8
JournalCirculation
Volume121
Issue number15
DOIs
StatePublished - Apr 2010

Fingerprint

Young Adult
Atrioventricular Block
Heart Failure
Antinuclear Antibodies
Population
Survival
Heart Diseases
Ventricular Dysfunction
Ventricular Function
Natural History
Stroke Volume
Antibodies

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 journalArticle

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. / Effect of long-term right ventricular pacing in young adults with structurally normal heart. In: Circulation. 2010 ; Vol. 121, No. 15. pp. 1698-1705.
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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

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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.

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KW - Cardiac pacing

KW - Congenital

KW - Death

KW - Follow-up studies

KW - Heart defects

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