Cardiac resynchronization therapy in adults with congenital heart disease
Zeliha Koyak1,2, Joris R de Groot1, Ahmed Krimly3
1Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands.
Insights
Cardiac resynchronization therapy (CRT) effectively treats heart failure in adults with congenital heart disease (CHD), showing a 77% response rate. This treatment offers comparable success to acquired heart disease, despite anatomical complexities.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Cardiac Electrophysiology
Background:
- Heart failure is a primary cause of morbidity and mortality in adults with congenital heart disease (CHD).
- Limited data exists on the efficacy and outcomes of cardiac resynchronization therapy (CRT) in this specific patient population.
Purpose of the Study:
- To investigate the effectiveness of cardiac resynchronization therapy (CRT) in improving outcomes for adults with congenital heart disease (CHD).
Main Methods:
- A retrospective study analyzed 48 adult CHD patients who underwent CRT between 2003 and 2021 across four tertiary centers.
- Patient response was defined by improvement in NYHA functional class and/or systemic ventricular ejection fraction by at least one category.
- Echocardiography assessed ventricular function; median follow-up was 2.6 years.
Main Results:
- Overall, 77% of patients (37 out of 48) responded to CRT, demonstrating improved NYHA class and/or ventricular function.
- The median age of patients receiving CRT was 47 years, with 77% being male.
- Among non-responders (11 patients), three died and four underwent heart transplantation.
Conclusions:
- Cardiac resynchronization therapy (CRT) in adults with CHD achieved a success rate comparable to patients with acquired heart disease.
- Despite complex anatomy and technical challenges, CRT is feasible in this population.
- Further research is necessary to establish optimal patient selection criteria and long-term outcome guidelines for CRT in CHD.
Aims:
In adults with congenital heart disease (CHD) heart failure is one of the leading causes of morbidity and mortality but experience with and reported outcome of cardiac resynchronization therapy (CRT) is limited. We investigated the efficacy of CRT in adults with CHD.
Methods And Results:
This was a retrospective study including 48 adults with CHD who received CRT since 2003 in four tertiary referral centres. Responders were defined as patients who showed improvement in NYHA functional class and/or systemic ventricular ejection fraction by at least one category. Ventricular function was assessed by echocardiography and graded on a four point ordinal scale. Median age at CRT was 47 years (range 18-74 years) and 77% was male. Cardiac diagnosis included tetralogy of Fallot in 29%, (congenitally corrected) transposition of great arteries in 23%, septal defects in 25%, left sided lesions in 21%, and Marfan syndrome in 2% of the patients. The median follow-up duration after CRT was 2.6 years (range 0.1-8.8). Overall, 37 out of 48 patients (77%) responded to CRT either by improvement of NYHA functional class and/or systemic ventricular function. There were 11 non-responders to CRT. Of these, three patients died and four underwent heart transplantation.
Conclusion:
In this cohort of older CHD patients, CRT was accomplished with a success rate comparable to those with acquired heart disease despite the complex anatomy and technical challenges frequently encountered in this population. Further studies are needed to establish appropriate guidelines for patient selection and long term outcome.
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