Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study

Abstract

Background The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality. Methods and Results This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18–77) years at initiation of CRT. Median follow‐up time was 4.1 (25th–75th percentile, 1.3–8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro‐transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th–75th percentile, II–III; after CRT: II, 25th–75th percentile, II–III; P =0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds; P =0.003) in patients with pre‐CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long‐term follow‐up with a marginal but significant increase in SRV function (before CRT; 30%, 25th–75th percentile, 25–35; after CRT: 31%, 25th–75th percentile, 21–38; P =0.049). In contrast, no beneficial change in the above‐mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow‐up, and mortality at latest follow‐up was 21.3%. Conclusions This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing‐induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.

Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study

“…Despite the acknowledgment that the effects of CRT are likely variable among different types of CHD, dedicated studies on the long-term survival in the CHD population have been limited to patients with systemic right ventricular circulation and Fontan physiology. 12,[47][48][49][50][51] Survival data from various CHD population with CRT have reported 5-year survival rates up to 80%, which is in accordance with the findings in the current study (79%). [47][48][49][50][51] Patients with TOF may, therefore, represent another large CHD group amenable to CRT with reasonable long-term outcomes.…”

Outcomes of cardiac resynchronization therapy in congenital heart disease: A meta‐analysis and systematic review

“…Thus, the final analysis included 14 studies with 595 patients. All 14 studies were observational studies 16–29 . The literature retrieval, review, and selection process are illustrated in Figure 1.…”

“…All 14 studies were observational studies. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] The literature retrieval, review, and selection process are illustrated in Figure 1. The characteristics and quality assessment of the included studies are presented in Table 1.…”

Congenitally corrected transposition: not correct at all

“…Primary cardiac resynchronization therapy (CRT) or biventricular pacing is associated with less systemic ventricular dysfunction when compared with single subpulmonary ventricular lead pacing [7,16 ▪ ]. CRT in systemic mRV patients with previous traditional pacing results in improved QRS duration and New York Heart Association functional class [27 ▪ ]. However, the response to biventricular pacing is variable, and the benefit of CRT in the setting of a narrow QRS is not yet established.…”