Cardiac Resynchronization Therapy (and Multisite Pacing) in Pediatrics and Congenital Heart Disease: Five Years Experience in a Single Institution

Abstract

Children and CHD patients treated with CRT have acute improvement in ventricular function, but implantation may require individualized planning and unconventional approaches. Future important goals include preimplant determination of CRT responders in pediatric and CHD patients, optimizing lead placement and programing, as well as long-term CRT device management issues.

Cardiac Electrical System Involvement in Alström Syndrome: Uncommon Causes of Dilated Cardiomyopathies

“…Ventricular resynchronization has been found to improve functional outcomes and survival in adults with cardiomyopathy, [23][24][25][26][27] and biventricular pacing has improved cardiac function in pediatric patients with cardiomyopathy. [28][29][30] Given that both patients described in this report had early documentation of left bundle branch block, larger cohorts of patients with Alström syndrome should be evaluated with regard to conduction system involvement and possible response rates to cardiac resynchronization therapy. It has been our practice to follow published indications for both ICD and/or biventricular resynchronization therapy based on cardiac dysfunction and QRS duration.…”

Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance

“…However, the presence of large Thebesian veins and extensive collateralization between the RV and LV at both anterior and posterior interventricular grooves via the anterior intraventricular vein and middle cardiac vein offer alternative routes for pacing of the morphologic RV anteriorly or posteriorly 37. Alternatively, biV pacing may be performed by surgical placement of epicardial LV and RV pacing leads or with a hybrid approach that involves surgical placement of an epicardial RV pacing lead and transvenous placement of an endocardial LV lead 33, 38…”

Assessment and Treatment of Systemic Right Ventricular Dyssynchrony

“…2 According to 3 multicenter retrospective cohorts, response defined as NYHA improvement ≥1 class or RVEF improvement was observed in only 2 of 9 patients (22%), 3 19 of 27 patients (79%), 4 and NYHA improvement was observed in 13 of 17 patients (76%). 5 Even in the study reporting a relatively good response, 4 the response rate was significantly less than that of systemic left ventricule (LV) patients.…”