Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2020 Dec;6(14):1762-1772. doi: 10.1016/j.jacep.2020.06.006. Epub 2020 Aug 26.
This study describes a single center experience with the use of cardiac resynchronization therapy (CRT) in a difficult patient population, including single systemic right ventricles (RVs), subpulmonary RVs, and left ventricles (LVs) with right bundle branch block (RBBB).
CRT remains challenging in the congenital heart disease population.
Consecutive patients undergoing resynchronization of single RVs, subpulmonary RVs, or LVs in the setting of RBBB were identified between 2016 and 2019. Patients who had CRT performed for complete heart block or had <3 months of follow-up were excluded. Patients underwent pre-procedural advanced imaging by echocardiogram, computed tomography, or cardiac magnetic resonance to assess ventricular function and synchrony; intraoperative mapping was performed to identify optimal lead placement.
All patients undergoing resynchronization presented with at least moderate systolic ventricular dysfunction in the setting of intrinsic atrioventricular nodal conduction and RBBB. Seven patients were identified. Two patients underwent CRT of a single RV, 3 with subpulmonary RVs and 2 with systemic LVs. The median age at CRT was 5 years (range 0.6 to 48 years). The median follow-up was 9 months (range 3 to 18 months). The median baseline QRS duration was 180 ms (range 115 to 260ms). Post-CRT, the QRS duration decreased by a median of 34% (range 19% to 38%). All patients had improvement in their systolic ventricular function.
Targeted resynchronization in systemic and subpulmonary RVs can be used to improve ventricular function and heart failure in the congenital heart disease population. Similar techniques can be applied to successfully treat patients with LV dysfunction and RBBB and improve their long-term outcomes.
本研究描述了在包括单全心室（RV）、肺动脉下 RV 和伴有右束支传导阻滞（RBBB）的左心室（LV）在内的困难患者群体中应用心脏再同步治疗（CRT）的单中心经验。
CRT 在先天性心脏病患者中仍然具有挑战性。
在 2016 年至 2019 年间，确定了在 RBBB 背景下接受单全心室、肺动脉下 RV 或 LV 再同步治疗的连续患者。排除了因完全性心脏传导阻滞而行 CRT 或随访时间<3 个月的患者。所有患者均接受术前超声心动图、计算机断层扫描或心脏磁共振检查以评估心室功能和同步性；术中进行标测以确定最佳导线位置。
所有接受再同步治疗的患者均存在固有房室结传导和 RBBB 背景下至少中度收缩性心室功能障碍。共确定了 7 例患者。其中 2 例患者接受单全心室 CRT，3 例患者接受肺动脉下 RV CRT，2 例患者接受系统 LV CRT。CRT 时的中位年龄为 5 岁（范围 0.6 至 48 岁）。中位随访时间为 9 个月（范围 3 至 18 个月）。基线时 QRS 时限的中位数为 180ms（范围 115 至 260ms）。CRT 后，QRS 时限中位数降低了 34%（范围 19%至 38%）。所有患者的收缩性心室功能均得到改善。
在系统性和肺动脉下 RV 中进行靶向再同步治疗可改善先天性心脏病患者的心室功能和心力衰竭。类似的技术可成功用于治疗伴有 LV 功能障碍和 RBBB 的患者，并改善其长期预后。
