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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Cardiac resynchronization therapy or sequential pacing in failing Mustard?
Giovanni Morani1, Giovanni Battista Luciani, Anna Manica
1Division of Cardiology, University of Verona, Verona, Italy. giovanni.morani@azosp.vr.it
Journal of Electrocardiology
|September 14, 2010
Summary
Patients with atrial switch procedures for congenital heart disease may benefit from dual-chamber pacemakers. Upgrading to DDD mode improved cardiac function, challenging traditional selection criteria for cardiac resynchronization therapy.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Electrophysiology
Background:
- Atrial switch procedures (Mustard, Senning) were primary treatments for transposition of the great arteries (1960s-1980s).
- Systemic (right) ventricular failure is a common complication in adults post-atrial switch.
- Cardiac resynchronization therapy (CRT) is a potential treatment for heart failure in this population.
Observation:
- A case report details a 30-year-old woman with congenital heart disease (CHD) and a prior Mustard procedure.
- The patient underwent an upgrade from a single-chamber to a dual-chamber pacemaker.
- Native QRS duration did not predict synchrony or cardiac output improvements.
Findings:
- Dual-chamber pacing (DDD mode) with a short atrioventricular delay and a broad QRS demonstrated improved functional cardiac performance.
- Traditional CRT selection parameters (ejection fraction, QRS duration) are less studied and potentially less reliable in postoperative CHD.
- Postoperative CHD can present unique asynchronous patterns with unpredictable hemodynamic outcomes.
Implications:
- Dual-chamber pacing may offer benefits for heart failure management in adults with prior atrial switch procedures.
- Novel criteria may be needed to optimize CRT candidate selection in complex congenital heart disease.
- Further research is warranted to understand asynchrony and guide therapy in this unique patient group.
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