Is Resynchronization Pacing Proarrhythmic Among Congenital Heart Patients? An Evaluation and Review

Area of Science:

• Cardiology
• Congenital Heart Disease
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) is used for heart failure (HF) in congenital heart disease (CHD) patients.
• Long-term CRT outcomes and proarrhythmic potential in younger CHD patients are not well-established.
• This study reviews arrhythmia burden in CHD-HF patients over 20 years.

Purpose of the Study:

• To evaluate the long-term safety and efficacy of CRT in congenital heart disease patients with heart failure.
• To assess the incidence of arrhythmias (both pre-existing and de novo) in CHD-HF patients undergoing CRT.
• To compare outcomes between CRT recipients and those on medical management.

Main Methods:

• A continuous review of 45 CHD-HF patients (NYHA II-IV) from 1999-2024.
• Comparison of 27 CRT recipients versus 18 patients on medical management (MM).
• Documentation of pre-existing and de novo arrhythmias throughout 1-20 years of follow-up.

Main Results:

• No new-onset arrhythmias were observed in any patient group.
• Pre-existing arrhythmias were present in 38% of patients in both CRT and MM groups.
• CRT significantly improved survival free from heart transplant or death at 10 years (44% vs. 13%, p < 0.0001).

Conclusions:

• Effective CRT application benefits CHD-HF patients without increasing arrhythmia burden.
• Pre-existing arrhythmias in CHD-HF patients highlight persistent intrinsic myocellular issues.
• CRT is a safe and effective therapy for select CHD-HF patients when applied appropriately.