Cardiac resynchronisation therapy among adults with a systemic right ventricle: a multicentre experience

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Cardiac resynchronisation therapy (CRT) is a standard treatment for heart failure (HF) in acquired heart disease.
• Its efficacy in adults with congenital heart disease (CHD) and a systemic right ventricle (sRV) is not well-established.
• This study investigates CRT outcomes in the sRV population.

Purpose of the Study:

• To evaluate the effectiveness of CRT in improving survival and reducing HF-related events in adults with an sRV.
• To identify factors associated with outcomes following CRT implantation in this unique patient group.

Main Methods:

• An international, retrospective study involving 105 adult patients with sRV who underwent CRT across 33 centers.
• Patients had diagnoses including transposition of the great arteries (TGA) with atrial switch or congenitally corrected TGA.
• Primary endpoint: overall survival and HF-free survival. Secondary endpoint: composite of death, HF hospitalization, heart transplant, mechanical support, or ventricular tachycardia/ICD therapies.

Main Results:

• CRT implantation was performed in 3.5% of the studied sRV population, with a median follow-up of 4.6 years.
• No significant improvements were observed in B-type natriuretic peptide, peak VO2, or tricuspid regurgitation severity post-CRT.
• Multivariable analysis revealed CRT and older age were independently associated with poorer outcomes (death and HF hospitalization).

Conclusions:

• In the largest reported cohort of sRV patients, CRT implantation was not associated with improved survival.
• CRT was independently linked to worse outcomes in this population, even after propensity score matching and multivariable adjustment.
• Further research is needed to understand the role and potential risks of CRT in adults with sRV.