Merchant Faisal M, Kella Danesh, Book Wendy M, Langberg Jonathan J, Lloyd Michael S
Emory University School of Medicine, Atlanta, Georgia.
Pacing Clin Electrophysiol. 2014 Mar;37(3):321-8. doi: 10.1111/pace.12284. Epub 2013 Oct 25.
Although left ventricular (LV) systolic dysfunction is known to occur in adults with repaired Tetralogy of Fallot (TOF), the effects of cardiac resynchronization therapy (CRT) are not well characterized.
We retrospectively divided all patients with repaired TOF and impaired LV ejection fraction (LVEF ≤ 40%) undergoing CRT at our institution (n = 10) into two groups: de novo CRT (group A, n = 6) or upgrade from existing device (group B, n = 4). Echocardiograms were reviewed at baseline, medium-term (>6 months post-CRT), and long-term follow-up. CRT response was defined as reduction in LV end-systolic volume (LVESV) ≥15% at medium term.
Age at surgical repair was 13.1 ± 16.0 years, age at CRT was 44.4 ± 12.5 years, and baseline LVEF was 24.0 ± 10.5%. Group A demonstrated a preponderance of right ventricular (RV) conduction delay, whereas all patients in group B demonstrated RV pacing at baseline. At medium-term follow-up, patients in group A showed significant improvements in LVEF, LV end-diastolic volume (LVEDV), and LVESV. Group B also demonstrated a significant improvement in LVEF with favorable trends in LV volumes. Of nine patients with complete data at medium term, eight showed evidence of CRT response. Average long-term follow-up was 53.4 ± 29.3 months. At long-term follow-up, LVEF, LVEDV, and LVESV remained numerically better than baseline, although the results were no longer significant.
Adult patients with repaired TOF and LV systolic dysfunction demonstrate significant medium-term response to CRT, even among those with RV conduction delay. The long-term impact of CRT in this population requires further characterization.
虽然已知法洛四联症（TOF）修复后的成人会出现左心室（LV）收缩功能障碍，但心脏再同步治疗（CRT）的效果尚未得到充分描述。
我们回顾性地将在我院接受CRT治疗且左心室射血分数（LVEF）受损（LVEF≤40%）的所有TOF修复患者（n = 10）分为两组：初次CRT（A组，n = 6）或从现有装置升级（B组，n = 4）。在基线、中期（CRT后>6个月）和长期随访时复查超声心动图。CRT反应定义为中期左心室收缩末期容积（LVESV）减少≥15%。
手术修复时的年龄为13.1±16.0岁，CRT时的年龄为44.4±12.5岁，基线LVEF为24.0±10.5%。A组右心室（RV）传导延迟占优势，而B组所有患者在基线时均表现为RV起搏。在中期随访时，A组患者的LVEF、左心室舒张末期容积（LVEDV）和LVESV有显著改善。B组的LVEF也有显著改善，左心室容积呈良好趋势。在中期有完整数据的9例患者中，8例显示有CRT反应的证据。平均长期随访时间为53.4±29.3个月。在长期随访时，LVEF、LVEDV和LVESV在数值上仍优于基线，尽管结果不再显著。
TOF修复后且有LV收缩功能障碍的成年患者对CRT有显著的中期反应,即使在有RV传导延迟的患者中也是如此。CRT对该人群的长期影响需要进一步描述。
