Cardiac resynchronization therapy in patients with congenital heart disease

Adults with congenital heart lesions constitute a rapidly growing group of patients with cardiovascular disease. This nascent demographic phenomenon is creating major issues concerning the optimal management of these patients, in whom sudden death and progressive heart failure are predominant causes of death. Ventricular dyssynchrony appears to be very common in this population and can appear early in the history of the disease. Recently, cardiac resynchronization therapy (CRT) has emerged as a potential treatment option for patients with congenital heart disease (CHD). In this paper, we review the clinical evidence for the role of CRT in a number of different groups of patients with congenital heart lesions. In particular, we focus on whether there is a plausible mechanistic role for CRT and, if so, whether this results in acute and longer-term beneficial effects. We conclude that CRT shows promise as a potential treatment option for patients with CHD and ventricular impairment, but larger clinical outcome studies are required before definitive guidance can be issued.