CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
138
AFRICA
patients, aged two and five years, respectively, have shown compres-
sion of cardiac structures identified by chest radiography and echo-
cardiography. One underwent cardiac catheterisation without angio-
graphic evidence of coronary compromise. The other underwent lead
revision without antecedent angiography. Both of these children had
successful lead adjustments with the compressing portions of the
leads re-positioned and the redundant portions of the leads anchored
to the diaphragm with sutures.
Conclusions:
An ongoing review of all 93 patients who have under-
gone epicardial pacemaker lead placement at our centre is underway.
Estimating the degree of cardiac compression by conventional means
is limited and requires a high index of suspicion along with investi-
gations including echocardiography, radiography, angiocardiography
and CT angiography. No single modality is definitive. We caution all
physicians involved with patients who have epicardial pacing systems
about this rare but important and potentially lethal complication asso-
ciated with pacemaker lead placement.
88: TOWARD BETTER VENTRICULAR PACING IN
PATIENTS WITH A SYSTEMIC RIGHT VENTRICLE
Irene E van Geldorp
1,2
, Pierre Bordachar
1
, Joost Lumens
1,2
, Maxime
de Guillebon
1
, Zachary I Whinnett
1,3
, Frits W Prinzen
2
, Michel
Haissaguerre
1
, Tammo Delhaas
2
, Jean-Benoit Thambo
1
1
Hopital Cardiologique du Haut Leveque, University Victor Segalen,
and Bordeaux University Hospital, Bordeaux, France
2
Cardiovascular Research Institute, Maastricht University, Maastricht,
the Netherlands
3
International Centre for Circulatory Health, National Heart and
Lung institute, Imperial College, London
Background
: Patients treated by atrial redirection surgery (Senning
or Mustard procedure) for transposition of the great arteries (TGA),
have an important risk for heart failure caused by dysfunction of the
systemic RV. Conventional non-systemic ventricular pacing (non-
systVP) may even further increase this risk. We investigated whether
these patients may benefit from biventricular pacing (BiVP) and/or
single-site systemic ventricular pacing (systVP).
Methods and Results
: During clinically indicated catheterisation
in nine patients with TGA and status post-atrial redirection surgery
(SenningMustardTGA), endocardial ventricular stimulation (over-
drive DDD-mode, 80–90 beats/min) was applied with temporary
pacing leads at the non-systemic and the systemic ventricle. Acute
changes in dP/dt
max
and systolic pressure of the systemic ventricle,
as induced by non-systVP, systVP and BiVP compared to reference,
were assessed with a pressure wire within the systemic ventricle.
Reference was AAI pacing with similar heart rate (
n
=
7), or non-syst-
VP at a lower heart rate than during stimulation at experimental sites
(85 vs 90 beats/min;
n
=
2). Systemic dP/dt
max
and systolic ventricular
pressure were significantly higher during systVP (+15.6 and +5.1%,
respectively) and BiVP (+14.3 and +4.9%, respectively, compared
with non-systVP). In six out of seven patients, systemic dP/dt
max
was
even higher during BiVP and systVP than during AAI pacing.
Conclusions
: In a population of patients with SenningMustardTGA,
acute haemodynamic effects of endocardial systVP and BiVP were
significantly and equally better than those of non-systVP. Single-site
systVP and BiVP might also be beneficial in patients with a systemic
RV and intrinsic ventricular dyssynchrony.
90: EVALUATION OF LEFT VENTRICULAR SYSTOLIC
FUNCTION WITH THE USE OF TISSUE DOPPLER ECHO-
CARDIOGRAPHY IN CHILDREN WITH PRIMARY ARTE-
RIAL HYPERTENSION
Jerzy Stanczyk
1
, Justyna Zamojska
1
, Katarzyna Niewiadomska-
Jarosik
1
, Agnieszka Wosiak
2
1
University Hospital No 4, Department of Paediatric Cardiology and
Rheumatology, Medical University of Lodz, Poland
2
Institute of Information Technology, Technical University of Lodz,
Poland
Background:
Arterial hypertension (HA) has become an increasing
problem in recent years. The aim of the study was to assess the left
ventricular systolic function in children with primary arterial hyper-
tension with the use of tissue Doppler method.
Methods:
The analysis included 30 children, 10–18 years old (mean
15.4
±
2.06) with diagnosed primary arterial hypertension, without
overweight or obesity. The control group included 30 children, 10–18
years old (mean 15.43
±
2.08) with normal values of arterial pressure.
All patients underwent: physical examination, manual measurements
of arterial pressure, ambulatory blood pressure monitoring, echocar-
diographic examination with cardiac function evaluation with the
use of standard parameters (ejection fraction, shortening fraction,
myocardial performance index) and tissue Doppler examination
(systolic mitral annular velocity profile and regional function param-
eters: velocity, strain, strain rate).
Results:
Mean values of ejection fraction (EF) as well as shortening
fraction (SF) were correct in both groups of patients. Mean values
of left ventricular myocardial performance index were significantly
higher in children with arterial hypertension (0.46
±
0.08 vs 0.36
±
0.03). Significantly lower mean values of systolic mitral annular
velocity profile at the intraventricular septum (Sm) and at the lateral
level (Sml) were found in children with HA (respectively: 8.7
±
1.27
and 11.66
±
2.84 cm/s vs 10.9
±
2.19 and 16.16
±
3.30 cm/s). Mean
values of regional function parameters (velocity, strain, strain rate)
were significantly lower in the hypertensive children group.
Conclusions:
In children with primary arterial hypertension, on the
basis of evaluation the parameters with the use of tissue Doppler
method, subclinical systolic dysfunction of the left ventricle was
observed. Left ventricular systolic function, estimated with the use of
standard echocardiographic indices was normal, except for myocar-
dial performance index, the value of which was significantly higher
compared to the control group.
91: SYNCOPE UNIT IN PAEDIATRIC POPULATION: A
SINGLE-CENTRE EXPERIENCE
Zakaria Jalal
1
, Xavier Iriart
1
, Maxime De Guillebon
1
, Cecile
Escobedo
1
, Jean-Benoit Thambo
1
1
Congenital and Paediatric Cardiology Department, CHU Bordeaux,
Pessac, France
Background:
Syncopes are frequent in the paediatric population.
The majority are benign but, for a minority of children, a cardiac
disease is the underlying cause and has to be recognised promptly, as
it can be fatal. Syncope units developped in adult populations have
demonstrated major improvement in diagnostic processes, reduction
in hospitalisation time, with favourable long-term outcomes. We
report our experience of syncope management in chidren and adoles-
cents through a dedicated syncope unit.
Methods:
In this ongoing study, we prospectively enrolled 45
consecutive patients (13
±
3 years, 65% male) between January
2011 and June 2012, referred for loss of consciousness (LOC), in
a dedicated paediatric syncope unit involving a paediatric cardiolo-
gist, nurse, physiotherapist and psychologist. All patients underwent
initial evaluation including medical history assessment, physical
examination, 12-lead ECG and echocardiography to exclude non-
cardiogenic syncopes. If initial assessement was abnormal, they
underwent targeted tests that differed according to suspected aetiol-
ogy. Patients with neurocardiogenic syncope underwent specific
physiotherapy training and a consultation with a psychologist.
Results:
The most common causes of LOC were neurocardio-
genic syncope: 32 patients (71%) and psychogenic LOC: 11 patients
(23%). One patient (3%) had a long QT syndrome and received
beta-blocker therapy. One patient had typical epileptic seizures and
was transferred to a neurology department. Mean hospitalisation
time was 0.9
±
0.5 days. Head-up tilt testing was positive in 62%
with neurocardiogenic syncope. Echocardiograms and exercise tests
were not contributive for diagnosis. After a mean follow up of 9
±
4
months, including physiotherapy and/or phychological care, syncope
reccurred in five patients (12%).
