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Classic-pattern dyssynchrony and electrical activation delays in pediatric dilated cardiomyopathy

Daniel Forsha1, Cameron Slorach2, Ching Kit Chen2

  • 1Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|July 27, 2014
PubMed

Insights

Classic-pattern dyssynchrony (CPD) was found in 12% of pediatric dilated cardiomyopathy (DCM) patients, indicating potential for cardiac resynchronization therapy (CRT) response. This finding is crucial for identifying pediatric DCM candidates for CRT.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Imaging
  • Electrophysiology

Background:

  • Pediatric dilated cardiomyopathy (DCM) often leads to heart failure, transplantation, or death, with limited treatment options.
  • Cardiac resynchronization therapy (CRT) shows promise for some children with DCM, but predicting response remains a challenge.
  • Identifying potential CRT candidates is vital given the high mortality in pediatric DCM.

Purpose of the Study:

  • To investigate the presence of classic-pattern dyssynchrony (CPD) in pediatric DCM patients.
  • To determine if CPD is associated with electrical activation delays in this population.
  • To assess the potential of CPD as a predictor of CRT response in pediatric DCM.

Main Methods:

  • Retrospective analysis of echocardiograms from 59 pediatric DCM patients using 2D speckle-tracking strain analysis for CPD.
  • Evaluation of electrocardiograms for activation delays, including prolonged QRS duration and left bundle branch block (LBBB).
  • Comparison with 40 age-matched control subjects without cardiac disease.

Main Results:

  • CPD was identified in 7 out of 59 (12%) pediatric DCM subjects; none were found in controls.
  • Prolonged QRS durations were observed in 22% of patients, with 2 meeting strict LBBB criteria.
  • Six of the seven CPD subjects exhibited prolonged QRS durations, suggesting an association between mechanical and electrical dyssynchrony.

Conclusions:

  • A small subgroup of pediatric DCM patients exhibits CPD, which may indicate potential benefit from CRT.
  • CPD is associated with electrical activation delays, though not exclusively with strict LBBB.
  • These findings support further prospective evaluation of CPD for guiding CRT in pediatric DCM.
Abstract

Keywords:
Cardiac resynchronization therapyDilated cardiomyopathyDyssynchronyPediatricStrain

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