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EXPRESS PUBLICATION

Cardiac resynchronization therapy: A novel adjunct to the treatment and prevention of systemic right ventricular failure

Jan Janouek, MD^*,*, Viktor Tomek, MD^*, Václav Chaloupeck, MD, PhD^*, Oleg Reich, MD, PhD^*, Roman A. Gebauer, MD^*, Josef Kautzner, MD, PhD and Bohumil Huín, MD, PhD^*

^* Kardiocentrum, University Hospital Motol
Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Manuscript received July 6, 2004; accepted August 17, 2004.

^* Reprint requests and correspondence: Dr. Jan Janouek, Kardiocentrum, University Hospital Motol, V úvalu 84, 150 06 Prague, Czech Republic (Email: jan.janousek{at}lfmotol.cuni.cz).

OBJECTIVES: This study aimed to evaluate the technical feasibility and hemodynamic benefit of cardiac resynchronization therapy (CRT) in patients with systemic right ventricle (RV).

BACKGROUND: Patients with a systemic RV are at high risk of developing heart failure. Cardiac resynchronization therapy may improve RV function in those with electromechanical dyssynchrony.

METHODS: Eight patients (age 6.9 to 29.2 years) with a systemic RV and right bundle-branch block (n = 2) or pacing from the left ventricle (LV) (n = 6) with a QRS intervalof 161 ± 21 ms underwent CRT (associated with cardiac surgery aimed at decrease in tricuspid regurgitation in 3 of 8 patients) and were followed-up for a median of 17.4 months.

RESULTS: Change from baseline rhythm to CRT was accompanied by a decrease in QRS interval (–28.0%, p = 0.002) and interventricular mechanical delay (–16.7%, p = 0.047) and immediate improvement in the RV filling time (+10.9%, p = 0.002), Tei index (–7.7%, p = 0.008), estimated RV maximum +dP/dt(+45.9%, p = 0.007), aortic velocity-time integral (+7.0%, p = 0.028), and RV ejection fraction by radionuclide ventriculography (+9.6%, p = 0.04). The RV fractional area of change increased from a median of 18.1% before resynchronization to 29.5% at last follow-up (p = 0.008) without a significant change in the end-diastolic area (+4.0%, p = NS).

CONCLUSIONS: The CRT yielded improvement in systemic RV function in patients with spontaneous or LV pacing-induced electromechanical dyssynchrony and seems to be a promising adjunct to the treatment and prevention of systemic RV failure.

Abbreviations and Acronyms   AV = atrioventricular   CRT = cardiac resynchronization therapy   RV = right ventricle/ventricular   LV = left ventricle/ventricular

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