Key result
Cardiac resynchronization therapy in pediatric and congenital heart disease patients increased mean systemic ventricular ejection fraction from 28.1% at baseline to 51.8% at late follow-up (p=0.012).
Why the study?
Adult CRT indications cannot be directly applied to pediatric and CHD patients due to anatomical and diagnostic heterogeneity, leaving optimal candidate selection unclear.
Does cardiac resynchronization therapy improve ventricular function and functional status in pediatric and congenital heart disease patients?
Observational (n=16)
No
Does cardiac resynchronization therapy improve ventricular function and functional status in pediatric and congenital heart disease patients?
Cardiac resynchronization therapy significantly improves systemic ventricular ejection fraction and functional class in pediatric and congenital heart disease patients, with a trend toward better response in those without structural CHD.
CRT may improve EF in pediatric CHD; leaves open need for RCTs before changing practice.
BACKGROUND AND OBJECTIVES: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT. METHODS: This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT. RESULTS: The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088). CONCLUSIONS: CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.
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Ahn et al. (2022) conducted an observational in Pediatric and congenital heart disease (n=16). Cardiac resynchronization therapy vs. Baseline (pre-implantation) was evaluated on Mean ejection fraction of the systemic ventricle at late follow-up (p=0.012). Cardiac resynchronization therapy in pediatric and congenital heart disease patients increased mean systemic ventricular ejection fraction from 28.1% at baseline to 51.8% at late follow-up (p=0.012).
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