16 Years of Cardiac Resynchronization Pacing Among Congenital Heart Disease Patients: Direct Contractility (dP/dt-max) Screening When the Guidelines Do Not Apply

JACC. Clinical Electrophysiology
Peter KarpawichKathleen Zelin

Abstract

The purpose of this study was to use direct cardiac resynchronization therapy (CRT)-paced contractility (dP/dt-max) response as a pre-implantation evaluation among patients with congenital heart disease (CHD) and follow clinical parameters and contractility indexes after CRT implantation. Patients with CHD often develop early heart failure with few therapeutic options, leading to heart transplantation (HT). Unfortunately, guidelines for CRT do not apply, and function evaluations by cardiac ultrasound are often inaccurate among CHD anatomies. Therefore, which CHD patients would benefit from CRT remains an enigma. From 1999 to 2015, 103 CHD patients with New York Heart Association (NYHA) functional class II to IV were listed for HT; 40 patients on optimal medical therapy were referred for paced contractility response cardiac catheterization before CRT consideration. If dP/dt-max improved ≥15% from baseline, these "responders" were given the option of CRT with continued follow-up after implantation. Of 40 patients studied, 26 (65%) (age 22 ± 8.2 years; 9 of 26 [35%] single or systemic right ventricle; 17 of 26 [65%] with pacemakers) met criteria for possible hemodynamic benefit and underwent CRT implantation. All 26 patients impro...Continue Reading

Citations

Nov 23, 2019·Heart Failure Reviews·Henry Chubb, Kara S Motonaga
Dec 7, 2018·Pacing and Clinical Electrophysiology : PACE·Jeremy P MooreReshma Biniwale
Mar 16, 2021·Journal of the American Heart Association·Peter KubušJan Janoušek
Sep 28, 2021·Journal of Cardiovascular Electrophysiology·Giacomo M CioffiGiovanni Battista Forleo

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