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
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 (, 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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