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Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation

Assami Rösner1, Tigran Khalapyan2, Håvard Dalen3

  • 1Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|December 13, 2017
PubMed

Insights

Classic-pattern dyssynchrony (CPD) is found in some Fontan patients and is linked to poorer heart function. This suggests CPD may predict response to cardiac resynchronization therapy in single-ventricle patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiac Electrophysiology

Background:

  • Single ventricle physiology presents unique challenges in cardiac mechanics.
  • Previous research indicated potential dyssynchrony in single ventricle hearts.
  • The Fontan procedure, a palliative surgery, creates a univentricular circulation model.

Purpose of the Study:

  • To investigate the prevalence of classic-pattern dyssynchrony (CPD) in patients with single-ventricle physiology post-Fontan palliation.
  • To determine the relationship between CPD, QRS duration, and myocardial function (systolic and diastolic) in this population.

Main Methods:

  • Retrospective cross-sectional study of 101 adolescent and adult patients who underwent Fontan procedure.
  • Visual assessment of strain curves for the presence of CPD.
  • Echocardiographic evaluation of systolic and diastolic function.

Main Results:

  • Fifteen percent of Fontan patients exhibited CPD.
  • CPD was more common in patients with two sizable ventricular components (43%) compared to dominant left (6%) or right (9%) ventricles (P=.016).
  • Patients with CPD showed significantly longer QRS duration, reduced ejection fraction, and impaired global systolic and diastolic strain compared to those without CPD.

Conclusions:

  • Classic-pattern dyssynchrony (CPD) is present in a notable proportion of Fontan survivors.
  • CPD is associated with diminished systolic and diastolic myocardial function.
  • These findings suggest CPD may be a valuable predictor for cardiac resynchronization therapy in univentricular hearts, warranting further investigation.
Abstract

Keywords:
Cardiac functionDyssynchronyFontan procedure

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