Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Late Outcomes of Pediatric and Congenital Heart Disease Patients Following Cardiac Resynchronization Therapy

  • Jeong Eun Ahn (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Susan Taejung Kim (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Hye Won Kwon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Sang Yun Lee (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Gi Beom Kim (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Jae Gun Kwak (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Woong Han Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Mi Kyoung Song (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Eun Jung Bae (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
  • Received : 2022.05.08
  • Accepted : 2022.08.16
  • Published : 2022.12.01
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Abstract

Background and Objectives: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT. Methods: This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT. Results: The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088). Conclusions: CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.

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References

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