Echocardiographically-Assisted Pacemaker Optimization in an Infant with Severe Left Ventricular Dysfunction - Abstract
A male newborn with pre-natal diagnosis of complex congenital heart disease (Taussig-Bing heart) was referred to our Institution for surgical treatment. The procedure was complicated by permanent AV block and consequent implantation of epicardial PMK in DDD mode. Despite the absence of any residual stenosis the patient poorly tolerated oral feeding and LV function progressively worsened. The PMK setting was changed to VVI and the optimal heart rate was chosen by using the left ventricular outflow tract velocity time integral. Twelve days after, the echocardiographic evaluation showed a dramatic improvement of LV shape and function. This case has demonstrated that systolic dysfunction in paced ventricles may be due not only to LV dyssynchrony but also to PMK-induced diastolic dysfunction.