Key result
CRT may improve clinical and echo outcomes in failing systemic right ventricles despite heterogeneous response definitions.
Why the study?
Guidelines differ regarding CRT for patients with a failing systemic right ventricle, as existing evidence has been limited to case reports and small retrospective cohorts.
Does cardiac resynchronization therapy improve clinical and echocardiographic outcomes in patients with a failing systemic right ventricle?
Systematic Review
Does cardiac resynchronization therapy improve clinical and echocardiographic outcomes in patients with a failing systemic right ventricle?
Cardiac resynchronization therapy may hold promise for treating failing systemic right ventricles in congenital heart disease, but standardized criteria for patient selection and response evaluation are urgently needed.
Answers are grounded in this paper and cite their sources.
CRT response heterogeneity in failing systemic RV precludes routine use; leaves open need for standardized prospective trials.
Patients with a systemic right ventricle (SRV) are at high risk for development of heart failure early in life. An SRV is encountered in patients with congenitally corrected transposition of the great arteries (CCTGA) or dextro-transposition of the great arteries (DTGA) with previous atrial switch repair (Mustard or Senning procedure). Progressive heart failure is one of the leading cause of mortality in these patients. Therefore, cardiac resynchronization therapy (CRT) has gained increasing momentum for use in this challenging congenital heart disease (CHD) population. However, current guidelines differ in recommendations for CRT in patients with an SRV as evidence supporting CRT has thus far only been described in case reports and retrospectively in relatively small study populations. In fact, the European Society of Cardiology Guideline for the management of grown-up congenital heart disease consider CRT to be 'experimental' in this population. This systematic review critically summarizes current literature on CRT in SRV patients and provides future perspectives for further research in this challenging and growing CHD population.
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Kharbanda et al. (2020) conducted a systematic review in Failing systemic right ventricle (CCTGA or DTGA with atrial switch repair). Cardiac resynchronization therapy vs. Standard care or baseline (no CRT) was evaluated. A systematic review of 14 retrospective studies found that while cardiac resynchronization therapy may offer clinical and echocardiographic improvements in patients with a failing systemic right ventricle, response definitions are highly heterogeneous.
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