Cardiac resynchronization therapy in congenital heart disease

Khairy, Paul; Fournier, A; Thibault, Bernard; Dubuc, Marc; Thérien, Johanne; Vobecky, Suzanne

doi:10.1016/j.ijcard.2005.06.065

Cited by 80 publications

(29 citation statements)

References 65 publications

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“…[373][374][375] Cardiac resynchronization therapy has been disappointing in the setting of L-TGA with RV dysfunction, although it could be considered when other options cannot be implemented. 376,377 Ebstein Malformation Ebstein malformation is a rare congenital malformation (≈1% of all congenital defects) and really should be considered an anomaly of the RV rather than an anomaly of the tricuspid valve. ACHD patients in the current era most likely present with progressive heart failure, tachyarrhythmias, or paradoxical embolism, and presentation for unoperated patients commonly can occur after their third decade.…”

Section: Isolated Pulmonary Valve Stenosismentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

205

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Section: Isolated Pulmonary Valve Stenosismentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

205

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“…These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19,56) and congenital (27,40,47) heart disease.…”

mentioning

confidence: 99%

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Quinn

Berberian

Cabreriza

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Temporary sequential biventricular pacing (BiVP) is a promising treatment for postoperative cardiac dysfunction, but the mechanism for improvement in right ventricular (RV) dysfunction is not understood. In the present study, cardiac output (CO) was optimized by sequential BiVP in six anesthetized, open-chest pigs during control and acute RV pressure overload (RVPO). Ventricular contractility was assessed by the maximum rate of increase of ventricular pressure (dP/dt max). Mechanical interventricular synchrony was measured by the area of the normalized RV-left ventricular (LV) pressure diagram (A PP ). Positive A PP indicates RV pressure preceding LV pressure, whereas zero indicates complete synchrony. In the control state, CO was maximized with nearly simultaneous stimulation of the RV and LV, which increased RV (P ϭ 0.006) and LV dP/dt max (P ϭ 0.002). During RVPO, CO was maximized with RV-first pacing, which increased RV dP/dt max (P ϭ 0.007), but did not affect LV dP/dtmax, and decreased the left-to-right, end-diastolic pressure gradient (P ϭ 0.023). Percent increase of RV dP/dt max was greater than LV dP/dtmax (P ϭ 0.014). There were no increases in end-diastolic pressure to account for increases in dP/dt max. In control and RVPO, RV dP/dtmax was linearly related to A PP (r ϭ 0.779, P Ͻ 0.001). The relation of CO to APP was curvilinear, with a peak in CO with positive A PP in the control state (P ϭ 0.004) and with A PP approaching zero during RVPO (P ϭ 0.001). These observations imply that, in our model, BiVP optimization improves CO by augmenting RV contractility. This is mediated by changes in mechanical interventricular synchrony. Afterload increases during RVPO exaggerate this effect, making CO critically dependent on simultaneous pressure generation in the RV and LV, with support of RV contractility by transmission of LV pressure across the interventricular septum. ventricular mechanics; interventricular synchrony; cardiac output; perioperative pacing; cardiac resynchronization therapy BIVENTRICULAR PACING (BiVP), or cardiac resynchronization therapy, is an important evolving therapeutic modality for congestive heart failure, reversing intraventricular conduction delay and left ventricular (LV) dysfunction intrinsic to dilated cardiomyopathy (2). In addition to long-term benefits for cardiac function and geometry in patients with various forms of chronic heart failure, BiVP is associated with acute improvements in ventricular systolic and diastolic function, inter-and intraventricular synchrony, and cardiac output (CO), with no cost to energy consumption (2). These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19, 56) and congenital (27, 40, 47) heart disease.Studies investigating sequential BiVP by alteration of the interventricular pacin...

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“…(66,67) Its role in congenital heart disease, however, is less well defined and it may not be appropriate to extrapolate the findings of the large trials performed in acquired heart failure to this population. (68,69) ACHD patients are a heterogeneous population and frequently have different forms of dyssynchrony, including a predominance of RBBB. Thus, for systemic right ventricles, it may be that CRT implantation should be considered as an adjunct to right AV valve intervention.…”

Section: Cardiac Resynchronisation Therapy (Crt)mentioning

confidence: 99%

“…Thus, for systemic right ventricles, it may be that CRT implantation should be considered as an adjunct to right AV valve intervention. (69,70) …”

Section: Cardiac Resynchronisation Therapy (Crt)mentioning

confidence: 99%

Management of advanced adult congenital heart disease

Bowater

2017

SAHJ

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As surgical techniques continue to develop, for example as seen with the Norwood procedure for hypoplastic left heart syndrome, the number of patients with the most complex forms of CHD will continue to increase along with their associated long term complications. Our ability to manage these patients appropriately, therefore, must also develop alongside. The purpose of this review is to examine the management of these patients once they have developed advanced disease, including drug therapy, devices, transplant and end of life care. In particular, the unique problems posed by patients with a systemic right ventricle (RV) and univentricular circulations are discussed. DRUG THERAPY IN HEART FAILUREIn patients with complex congenital heart disease, either palliated or unoperated, the development of ventricular dysfunction and clinical heart failure are common and as discussed above, is a common cause of morbidity and mortality in this population.

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Cardiac resynchronization therapy in congenital heart disease

Cited by 80 publications

References 65 publications

Congenital Heart Disease in the Older Adult

Congenital Heart Disease in the Older Adult

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Management of advanced adult congenital heart disease

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