Jeremy P Moore1, David Cho2, Jeannette P Lin3, Gentian Lluri3, Leigh C Reardon3, Jamil A Aboulhosn3, Abbie Hageman4, Kevin M Shannon5. 1. Division of Pediatric Cardiology, Department of Pediatrics UCLA Medical Center, University of California, Los Angeles, Los Angeles, California; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Los Angeles, California. Electronic address: jpmoore@mednet.ucla.edu. 2. Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California. 3. Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Los Angeles, California. 4. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. 5. Division of Pediatric Cardiology, Department of Pediatrics UCLA Medical Center, University of California, Los Angeles, Los Angeles, California; Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Los Angeles, California.
Abstract
BACKGROUND: Patients with congenitally corrected transposition of the great arteries (CCTGA) are at risk of congestive heart failure (CHF). There are limited data on cardiac resynchronization therapy (CRT) techniques and long-term outcomes in this population. OBJECTIVE: The purpose of this study was to determine implantation techniques and efficacy of CRT for CCTGA. METHODS: A 15-year retrospective review of patients with CCTGA undergoing CRT was performed. RESULTS: Twenty patients were identified (mean age 40.1 ± 15.3 years; baseline New York Heart Association class 2.0 [interquartile range 1.5-3.5]). Indication was pacing-induced ventricular dysfunction in 12 (60%), atrioventricular block with anticipation for >40% ventricular pacing in 5 (25%), and intact atrioventricular conduction with CHF and QRS prolongation in 3 (15%). A transvenous approach was successful in 18 of 19 patients (95%) in whom it was attempted, with cannulation of a posteroseptal ostium in 14 (78%), vein of Marshall in 2 (11%), and superior ectopic ostium in 2 (11%). Of patients with baseline CHF, 8 (67%) were acute responders, with loss of response in 2 patients (median 1.1 and 1.5 years, respectively). Of 4 patients referred for heart transplantation, 3 (75%) could be de-listed following CRT. Only lead location in the right ventricular outflow tract predicted poor CRT response (P = .026). Post-procedure, the QRS duration increased by 4.3 ms/y (P < .001) despite stable pacing characteristics. CRT revision was required in 4 patients for infection (n = 2) or phrenic nerve capture (n = 2) and was associated with loss of CRT response in 1 patient. CONCLUSION: A transvenous approach to CRT involving distinct coronary venous patterns is feasible for most patients with CCTGA anatomy. Long-term outcome is favorable, but is characterized by return of right ventricular dysfunction in some patients. Published by Elsevier Inc.
BACKGROUND:Patients with congenitally corrected transposition of the great arteries (CCTGA) are at risk of congestive heart failure (CHF). There are limited data on cardiac resynchronization therapy (CRT) techniques and long-term outcomes in this population. OBJECTIVE: The purpose of this study was to determine implantation techniques and efficacy of CRT for CCTGA. METHODS: A 15-year retrospective review of patients with CCTGA undergoing CRT was performed. RESULTS: Twenty patients were identified (mean age 40.1 ± 15.3 years; baseline New York Heart Association class 2.0 [interquartile range 1.5-3.5]). Indication was pacing-induced ventricular dysfunction in 12 (60%), atrioventricular block with anticipation for >40% ventricular pacing in 5 (25%), and intact atrioventricular conduction with CHF and QRS prolongation in 3 (15%). A transvenous approach was successful in 18 of 19 patients (95%) in whom it was attempted, with cannulation of a posteroseptal ostium in 14 (78%), vein of Marshall in 2 (11%), and superior ectopic ostium in 2 (11%). Of patients with baseline CHF, 8 (67%) were acute responders, with loss of response in 2 patients (median 1.1 and 1.5 years, respectively). Of 4 patients referred for heart transplantation, 3 (75%) could be de-listed following CRT. Only lead location in the right ventricular outflow tract predicted poor CRT response (P = .026). Post-procedure, the QRS duration increased by 4.3 ms/y (P < .001) despite stable pacing characteristics. CRT revision was required in 4 patients for infection (n = 2) or phrenic nerve capture (n = 2) and was associated with loss of CRT response in 1 patient. CONCLUSION: A transvenous approach to CRT involving distinct coronary venous patterns is feasible for most patients with CCTGA anatomy. Long-term outcome is favorable, but is characterized by return of right ventricular dysfunction in some patients. Published by Elsevier Inc.
Entities:
Keywords:
Cardiac resynchronization therapy; Congenital heart disease; Congenitally corrected transposition of the great arteries; Congestive heart failure; Heart transplantation; Systemic right ventricle