Is Resynchronization Pacing Proarrhythmic Among Congenital Heart Patients? An Evaluation and Review
Peter P Karpawich1, Kathleen Zelin1, Corinne Biggs1
1Section of Cardiology, Departments of Pediatrics, The Children's Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA.
Insights
Cardiac resynchronization therapy (CRT) effectively manages heart failure in congenital heart disease patients without causing new arrhythmias. Pre-existing arrhythmias remain a concern, indicating underlying issues in these patients.
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.
Background:
Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among older CRT recipients. This issue is largely unknown among younger CHD-CRT pts. This study presents up to a 20-year (y) continuous review of any arrhythmia (Arr) burden associated with CRT among CHD-HF pts.
Methods:
From 1999 to 2024, outcomes of 45 CHD-HF pts (NYHA II-IV) (age 4-57 y [mean 26]; 31% female) were compared between those on established medical management (MM) (n = 18) and CRT recipients (n = 27) followed continuously for 1-20 years. Pre-existing and any de novo Arr that occurred following CRT were documented. Clinical assessments were continuous.
Results:
Follow-up was for 1 to 20 y (mean 7.5 y ± 0.7 sem). Patient demographics (CRT vs. MM groups) were comparable. Pre-existing Arr were found in 16 pts (38%) from both groups: accelerated junction (one CRT), atrial flutter (one CRT; two MM), and ventricular tachycardia (six CRT; six MM). During follow-up, outcomes included 14 pt deaths and 7 heart transplants (HTs). Of these, pre-existing Arr were causative among three CRT recipients: two ≤ 2 y and one > 5 y after CRT. There were no new-onset Arr in any pt groups. CRT significantly improved patient survival free from HT or death at 10 y (44 vs. 13% [p < 0001]).
Conclusion:
When applied effectively, CRT benefits CHD-HF pts without causing additional arrhythmias. However, pre-existing Arr remain a concern reflecting persistently adverse intrinsic myocellular issues among CHD-HF pts.
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