Cardiac Resynchronization Therapy for Failing Single Ventricle Physiology
Yuji Tominaga1, Heima Sakaguchi2, Masashi Takeshita1
1Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, 565-8565, Japan.
Summary
Cardiac resynchronization therapy improved heart function and heart failure symptoms in single ventricle patients with dyssynchrony. This therapy shows promise for improving outcomes in this complex patient group.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Single ventricle physiology presents unique challenges in managing heart failure and ventricular dyssynchrony.
- Ventricular dyssynchrony contributes to poor outcomes in single ventricle patients, exacerbating heart failure symptoms.
Purpose of the Study:
- To evaluate the mid-term efficacy of cardiac resynchronization therapy (CRT) in patients with single ventricle physiology, heart failure, and ventricular dyssynchrony.
- To assess the impact of CRT on hemodynamic parameters, functional status, and long-term survival in this cohort.
Main Methods:
- Retrospective review of single ventricle patients undergoing CRT between 2010 and 2024.
- Dyssynchrony defined by QRS duration (≥130 ms) and mechanical assessment; CRT indications based on hemodynamic improvement.
- Patients categorized into Group G (post-bidirectional Glenn) and Group F (post-Fontan completion); analysis included survival, functional class, and organ function.
Main Results:
- CRT improved systemic ventricular ejection fraction (Group G: 30-40%, Group F: 30-53%) and cardiac index one year post-procedure.
- Five-year survival rates were high (89% in Group G, 82% in Group F); Fontan completion rate was 76% at 5 years in Group G.
- Group F showed improved brain natriuretic peptide levels, stable hepatic function, and no reported protein-losing enteropathy.
Conclusions:
- Cardiac resynchronization therapy effectively enhances systemic ventricular function and alleviates heart failure symptoms in single ventricle patients.
- CRT represents a potentially valuable therapeutic strategy for single ventricle patients experiencing heart failure and ventricular dyssynchrony, improving their quality of life and prognosis.
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