Cardiac resynchronization therapy among adults with a systemic right ventricle: a multicenter experience

Authors:
Preprint
Publisher website
Google Scholar
Abstract
Background: Cardiac Resynchronization Therapy(CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV. Methods: This analysis was part of an international, retrospective study of data from 33 centers including patients >18years with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA (ccTGA). The primary endpoint was overall survival. The secondary endpoint was a composite of death, hospitalization for HF, heart transplant, mechanical support, ventricular tachycardia/ICD therapies. Results: We identified 105 out of 1,721 patients(3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 [1.6-8] years. There was no overall QRS improvement (157±37 Vs 153±31 ms; p=0.2), which was limited to those with previous pacing (167±35 Vs 154± 28 ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peakVO 2 , tricuspid regurgitation severity by echocardiography. CRT complications occurred in 10 (9.5%), though there were usually minor. Patients with CRT were propensity-matched to controls according to age, sex, morphology (ccTGA/TGA), presence of complex disease, previous HF admission and sRV dysfunction at baseline. At univariable analysis, CRT (OR 4.02-95% CI:1.48-10.89; p=0.006), older age, and moderate to severe sRV dysfunction at baseline were predictive of death. By multivariable analysis, CRT (OR 2.1-95% CI:1.2-3.8; p=0.008), age (OR 1.03-95% CI:1.01-1.06; p=0.001) and moderate to severe sRV dysfunction (OR 2.5-95% CI:1.3-4.4; p=0.002) were independently associated with poorer outcome. After matching using only patients with subpulmonary ventricle pacing as controls, overall survival was still worse in CRT group (p=0.0057). Conclusion: In this retrospective study in the largest population thus far described with a sRV, CRT implant was not associated to improved survival, even after controlling for key confounders. Further studies with randomization are required to improve the selection of candidates with a sRV most likely to derive benefit from CRT, elucidate the optimal timing, and assess alternative strategies.

This publication has 25 references indexed in Scilit: