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Resynchronization Therapy for Patients with Congenital Heart Disease: Are We Ready for Prime Time?
Scott Anjewierden1, Peter F Aziz2
1Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure symptoms and hemodynamics in congenital heart disease (CHD) patients. While challenging to implant, CRT is a valuable treatment option for select CHD patients, especially those with systemic left ventricles.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenital heart disease (CHD) often leads to heart failure.
- Cardiac resynchronization therapy (CRT) is an established treatment for heart failure in the general population.
Purpose of the Study:
- To review and update the evidence for CRT in pediatric and adult patients with CHD.
- To assess the efficacy and feasibility of CRT in the unique context of CHD.
Main Methods:
- Systematic review of current literature on CRT in CHD.
- Analysis of studies reporting hemodynamic parameters, heart failure symptoms, and implantation techniques.
Main Results:
- CRT demonstrates benefits in improving hemodynamic parameters and reducing heart failure symptoms in CHD patients.
- Patients with a systemic left ventricle appear to derive the most significant benefit from CRT.
- Implantation challenges in CHD have been mitigated by surgical advances like lateral thoracotomies.
Conclusions:
- Cardiac resynchronization therapy is a valuable therapeutic option for carefully selected individuals with congenital heart disease and heart failure.
- Individualized patient selection and consideration of specific anatomic substrates are crucial for successful CRT outcomes in CHD.
- Further research is warranted to define optimal CRT strategies for diverse CHD anatomies.
Purpose Of Review:
This review aims to summarize and provide an update of evidence for cardiac resynchronization therapy (CRT) in pediatric and adult congenital heart disease (CHD).
Recent Findings:
CRT is a valuable tool in the treatment of heart failure in the setting of CHD. Current evidence points toward the ability of this therapy to increase hemodynamic parameters and reduce heart failure-related symptoms. Within the CHD population, patients with systemic left ventricles appear to benefit the most from CRT. Utilization of CRT in CHD has been technically difficult due to the complexity and variety of anatomic substrates. However, lateral thoracotomies and other advances have made implantation more feasible. The most up-to-date evidence continues to support the use of CRT in the heterogeneous population of CHD with careful and individualized patient selection. Further studies are needed to evaluate the utility of CRT for specific anatomic substrates within this population.
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