CLINICAL RESEARCH: CONGENITAL HEART DISEASE AND RESYNCHRONIZATION
Resynchronization Therapy in Pediatric and Congenital Heart Disease Patients
An International MultiCenter Study
Anne M. Dubin, MD, FACC*,*,
Jan Janousek, MD ,
Edward Rhee, MD, FACC ,
Margaret J. Strieper, DO, FACC ,
Frank Cecchin, MD, FACC||,
Ian H. Law, MD¶,
Kevin M. Shannon, MD#,
Joel Temple, MD, FACC**,
Eric Rosenthal, MD,
Frank J. Zimmerman, MD,
Andrew Davis, MD,
Peter P. Karpawich, MD, FACC||||,
Amin Al Ahmad, MD¶¶,
Victoria L. Vetter, MD, FACC##,
Naomi J. Kertesz, MD, FACC***,
Maully Shah, MD,
Christopher Snyder, MD,
Elizabeth Stephenson, MD, FACC,
Mathias Emmel, MD||||||,
Shubhayan Sanatani, MD¶¶¶,
Ronald Kanter, MD, FACC###,
Anjan Batra, MD**** and
Kathryn K. Collins, MD, FACC
* Lucile Packard Children’s Hospital, Palo Alto, California
University Hospital Motol, Prague, Czech Republic
St. Louis Children’s Hospital, St. Louis, Missouri
Children’s Healthcare of Atlanta, Atlanta, Georgia
|| Children’s Hospital Boston, Boston, Massachusetts
¶ Children’s Hospital of Iowa, Iowa City, Iowa
# Mattel Children’s Hospital, Los Angeles, California
** Arkansas Children’s Hospital, Little Rock, Arkansas
Guy’s Hospital, London, United Kingdom
University of Chicago Children’s Hospital, Chicago, Illinois
Royal Children’s Hospital, Melbourne, Australia
|||| Children’s Hospital of Michigan, Detroit, Michigan
¶¶ Stanford University Medical Center, Palo Alto, California
## Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
*** Texas Children’s Hospital, Houston, Texas
Seattle Children’s Hospital, Seattle, Washington
Yale-New Haven Children’s Hospital, New Haven, Connecticut
Hospital for Sick Children, Toronto, Canada
|| || || University of Cologne Medical Center, Cologne, Germany
¶¶¶ British Columbia Children’s Hospital, Vancouver, Canada
### Duke University Medical Center, Durham, North Carolina
**** Riley Children’s Hospital, Indianapolis, Indiana
UCSF Children’s Hospital, San Francisco, California
Manuscript received February 11, 2005;
revised manuscript received April 27, 2005,
accepted May 31, 2005.
* Reprint requests and correspondence: Dr. Anne M. Dubin, 750 Welch Road, Suite 305, Palo Alto, California 94304 (Email: amdubin{at}stanford.edu).
OBJECTIVES: Our objective was to evaluate the short-term safety and efficacy of cardiac resynchronization therapy (CRT) in children.
BACKGROUND: Cardiac resynchronization therapy has been beneficial for adult patients with poor left ventricular function and intraventricular conduction delay. The efficacy of this therapy in the young and in those with congenital heart disease (CHD) has not yet been established.
METHODS: This is a multi-center, retrospective evaluation of CRT in 103 patients from 22 institutions.
RESULTS: Median age at time of implantation was 12.8 years (3 months to 55.4 years). Median duration of follow-up was four months (22 days to 1 year). The diagnosis was CHD in 73 patients (71%), cardiomyopathy in 16 (16%), and congenital complete atrioventricular block in 14 (13%). The QRS duration before pacing was 166.1 ± 33.3 ms, which decreased after CRT by 37.7 ± 30.7 ms (p < 0.01). Pre-CRT systemic ventricular ejection fraction (EF) was 26.2 ± 11.6%. The EF increased by 12.8 ± 12.7 EF units with a mean EF after CRT of 39.9 ± 14.8% (p < 0.05). Of 18 patients who underwent CRT while listed for heart transplantation, 3 improved sufficiently to allow removal from the transplant waiting list, 5 underwent transplant, 2 died, and 8 others are currently awaiting transplant.
CONCLUSIONS: Cardiac resynchronization therapy appears to offer benefit in pediatric and CHD patients who differ substantially from the adult populations in whom this therapy has been most thoroughly evaluated to date. Further studies looking at the long-term benefit of this therapy in this population are needed.
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Abbreviations and Acronyms
| | CHD = congenital heart disease | | CRT = cardiac resynchronization therapy | | EF = ejection fraction | | ICD = implantable cardioverter-defibrillator | | NYHA = New York Heart Association |
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