Right Ventricular Pacing After Ventricular Septal Defect Closure Is Associated With Development of Cardiac Dysfunction

摘要

Post-operative atrioventricular block (POAVB) requiring permanent pacing is a known complication of congenital heart surgery with a reported incidence of 1% to 3% (1). Although pacemakers are lifesaving, their use can lead to pacing-induced cardiomyopathy (PICM). Evidence has shown that complex congenital heart disease may increase the risk of PICM. We hypothesized that even lower-complexity surgeries, such as ventricular septal defect (VSD) closure, complicated by POAVB requiring pacing, portends an increased risk of dysfunction due to augmented dys-synchrony. We performed a single-center retrospective case-control study to describe outcomes of patients with POAVB after isolated VSD closure and compared them with control groups consisting of: 1) patients who underwent VSD closure without permanent pacing: and 2) patients without structural heart disease who required pacing for congenital complete atrioventricular block (CCAVB). The primary outcomes were left ventricular (LV) systolic dysfunction and cardiac death (defined as death, cardiac transplantation, or ventricular assist device implantation). For purposes of cardiac function, serial echocardiography data were analyzed for measures of systolic function. Cardiac dysfunction was defined as an ejection fraction of <55%, plus the use of heart failure medication.