Author + information
- Received March 12, 2020
- Revision received June 2, 2020
- Accepted June 4, 2020
- Published online August 26, 2020.
- Douglas Y. Mah, MDa,∗ (, )
- Edward T. O’Leary, MDa,
- David M. Harrild, MD, PhDa,
- Diego Porras, MDa,
- Michelle Gurvitz, MDa,
- Gerald Marx, MDa,
- Rahul H. Rathod, MDa and
- Francis Fynn-Thompson, MDb
- aDepartment of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- bDepartment of Cardiovascular Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Douglas Y. Mah, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
Objectives This study describes a single center experience with the use of cardiac resynchronization therapy (CRT) in a difficult patient population, including single systemic right ventricles (RVs), subpulmonary RVs, and left ventricles (LVs) with right bundle branch block (RBBB).
Background CRT remains challenging in the congenital heart disease population.
Methods Consecutive patients undergoing resynchronization of single RVs, subpulmonary RVs, or LVs in the setting of RBBB were identified between 2016 and 2019. Patients who had CRT performed for complete heart block or had less than 3 months of follow-up were excluded. Patients underwent pre-procedural advanced imaging by echocardiogram, computed tomography, or cardiac magnetic resonance to assess ventricular function and synchrony; intraoperative mapping was performed to identify optimal lead placement.
Results All patients undergoing resynchronization presented with at least moderate systolic ventricular dysfunction in the setting of intrinsic atrioventricular nodal conduction and RBBB. Seven patients were identified. Two patients underwent CRT of a single RV, 3 with subpulmonary RVs and 2 with systemic LVs. The median age at CRT was 5 years (range 0.6 to 48 years). The median follow-up was 9 months (range 3 to 18 months). The median baseline QRS duration was 180 ms (range 115 to 260ms). Post-CRT, the QRS duration decreased by a median of 34% (range 19% to 38%). All patients had improvement in their systolic ventricular function.
Conclusions Targeted resynchronization in systemic and subpulmonary RVs can be used to improve ventricular function and heart failure in the congenital heart disease population. Similar techniques can be applied to successfully treat patients with LV dysfunction and RBBB and improve their long-term outcomes.
- cardiac resynchronization therapy
- left ventricular dysfunction
- right ventricle
- right bundle branch block
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 12, 2020.
- Revision received June 2, 2020.
- Accepted June 4, 2020.
- 2020 American College of Cardiology Foundation
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