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Successful cardiac resynchronization therapy in a 3-year-old girl with isolated left ventricular non-compaction and

Kazuyoshi Saito1, Keijirou Ibuki, Naoki Yoshimura

  • 1Department of Pediatrics, University of Toyama, Toyama, Japan.

Circulation Journal : Official Journal of the Japanese Circulation Society
|April 9, 2009
PubMed

Insights

Cardiac resynchronization therapy (CRT) improved heart failure in a child with left ventricular non-compaction (LVNC). This pediatric CRT treatment was effective even with a narrow QRS complex, suggesting improved long-term outcomes.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Engineering
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is established for adult heart failure, but its use in children, particularly those with left ventricular non-compaction (LVNC), is not well-defined.
  • Indications, efficacy, and long-term prognosis of pediatric CRT remain areas of active investigation.

Observation:

  • A 3-year-old girl with intractable heart failure due to isolated LVNC and a narrow QRS complex presented with severe left ventricular dysfunction (ejection fraction 29.3%) and mitral regurgitation.
  • Echocardiography revealed diffuse hypokinesis and significant dyssynchrony in LV wall motion, characterized by prominent trabeculations.

Findings:

  • Biventricular resynchronization via epicardial pacing was successfully performed, with optimal pacing sites identified using tissue Doppler imaging and AV delay optimized for maximal hemodynamic benefit.
  • Over a 2-year follow-up, the patient demonstrated substantial and sustained improvements in LV function and clinical status, with a significant decrease in BNP levels (1,960 to 82 pg/ml).
  • Notably, QRS duration remained unchanged (103 ms) post-CRT, indicating efficacy beyond traditional QRS widening criteria.

Implications:

  • Pediatric CRT can be a valuable therapeutic option for refractory heart failure in children, including those with LVNC and narrow QRS complexes.
  • This case suggests that CRT may improve the prognosis for pediatric patients with LVNC, challenging previous assumptions about QRS duration requirements.

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