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Early and late effects of cardiac resynchronization therapy in adult congenital heart disease

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Title: Early and late effects of cardiac resynchronization therapy in adult congenital heart disease
Authors: Li, W
Yin, Y
Dimopoulos, K
Shimada, E
Lascelles, K
Griffiths, S
Wong, T
Gatzoulis, M
Babu-Narayan, S
Item Type: Journal Article
Abstract: Background: There are limited data regarding cardiac resynchronization therapy (CRT) in adult congenital heart disease (ACHD). We aimed to assess early and late outcomes of CRT amongst patients with ACHD. Methods: We retrospectively studied ACHD patients receiving CRT (2004-2017). Clinical and echocardiographic data were analyzed at baseline, early (1.8±0.8 years) and late (4.7±0.8 years) follow-up after CRT. Results: Fifty-four ACHD patients (median age 46 years, range 18-73 years, 74% male) had CRT (biventricular paced >90%) and were followed for 5.7±3.0 years. Compared to baseline, CRT was associated with significant improvement at early follow-up in NYHA functional class, QRS duration and cardiothoracic ratio (P<0.05 for all); improvement in NYHA class was sustained at late follow-up. Amongst patients with a systemic left ventricle (LV; n=39), there was significant increase in LV ejection fraction (LVEF) and reduction in LV end-systolic volume at early and late follow up (P<0.05 for both). For patients with a systemic right ventricle (RV; n=15), there was a significant early but not late reduction in systemic RV basal and longitudinal diameters. Eleven patients died and 2 had heart transplantation unrelated to systemic ventricular morphology. Thirty-five (65%) patients responded positively to CRT but only baseline QRS duration was predictive of a positive response. Conclusions: CRT results in sustained improvement in functional class, systemic LV size and function. Patients with a systemic LV and prolonged QRS duration, independent of QRS morphology, were most likely to respond to CRT.
Issue Date: 5-Nov-2019
Date of Acceptance: 4-Sep-2019
URI: http://hdl.handle.net/10044/1/73266
DOI: 10.1161/JAHA.119.012744
ISSN: 2047-9980
Publisher: Wiley
Journal / Book Title: Journal of the American Heart Association
Volume: 8
Issue: 21
Copyright Statement: © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: FS/11/38/28864
Keywords: adult congenital heart disease
cardiac resynchronization therapy
ventricular function
1102 Cardiorespiratory Medicine and Haematology
Publication Status: Published
Article Number: e012744
Online Publication Date: 2019-10-28
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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