Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study
Rohit K Kharbanda1,2, Jeremy P Moore3, Michael S Lloyd4
1Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands.
Journal of the American Heart Association
|November 8, 2022
Summary
Cardiac resynchronization therapy (CRT) improved heart function and reduced QRS duration in select patients with a systemic right ventricle (SRV). However, benefits were mainly seen in those upgraded from existing pacing, not de novo CRT.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Electrophysiology
Background:
- Systemic right ventricle (SRV) is a complex congenital heart defect.
- Patients with SRV often experience heart failure and conduction abnormalities.
- Cardiac resynchronization therapy (CRT) is a treatment option for heart failure, but its outcomes in SRV are less understood.
Purpose of the Study:
- To evaluate early and late outcomes of CRT in SRV patients.
- To identify predictors of heart failure readmission and mortality in this population.
- To assess CRT's impact on functional status and SRV function.
Main Methods:
- Retrospective international multicenter study involving 13 centers.
- Included 80 adult patients with SRV (mean age 45±14 years).
- Analyzed outcomes in patients undergoing CRT upgrade vs. de novo CRT.
Main Results:
- CRT significantly improved functional class (NYHA) and QRS duration in patients upgraded to CRT (n=49).
- These improvements were sustained long-term, with a marginal increase in SRV function.
- No significant benefits were observed in patients receiving de novo CRT (n=31).
- Heart failure readmission occurred in 25% of patients; overall mortality was 21.3%.
Conclusions:
- CRT can consistently improve QRS duration and functional status in selected SRV patients with dysfunction and pacing-induced dyssynchrony.
- Benefits are more pronounced in patients upgraded to CRT compared to de novo implantation.
- Further research is needed to optimize CRT strategies for SRV patients.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
19
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
19
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
20
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
20
01:29Cardiomyopathy V: Interprofessional Care
27
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
27
01:22Heart Failure VI: Adjunct Therapies
25
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
25
01:21Cardiopulmonary Resuscitation I: Adult
44
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
44
01:30Heart Failure IV: Classification and Diagnostic Evaluation
27
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
27