Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
Cardiol Young. 2021 Jun;31(6):940-948. doi: 10.1017/S1047951120004795. Epub 2021 Jan 27.
In recent years, cardiac resynchronization therapy (CRT) has also started to be performed in the paediatric and CHD population. This study aimed to evaluate the efficacy of CRT in children with CHD.
Patients with CHD who underwent CRT treatment in our paediatric cardiology clinic between January, 2010 and January, 2020 were included in the study. Demographic findings, 12-lead electrocardiograms, echocardiograms, clinical characteristics, management strategies, and outcomes were reviewed systematically.
The study population consisted of 18 CHD patients who had been treated with CRT for 10 years in our institution. The median age was 11 years (2.2-18 years) and the median weight was 39 kg (10-81 kg). Systemic ventricle was left ventricle in 13 patients, right ventricle in 4 patients, and 1 patient had single-ventricle physiology. CRT implantation indications were as follows: dysfunction after permanent pacemaker in 11 patients, dysfunction after left bundle branch block in 4 patients, and systemic ventricular dysfunction in 3 patients. CRT implantation techniques were epicardial (n = 13), hybrid (n = 4), and transvenous (n = 1) methods. QRS duration significantly decreased after CRT implantation (160 versus 124 m/second, p < 0.05). Median systemic ventricle ejection fraction (EF) significantly increased after the procedure (30 versus 50%, p < 0.05). Fourteen patients (78%) were responders, two patients (11%) were superresponders, and two patients (11%) were non-responders after the CRT treatment. One patient deceased during follow-up. Median follow-up duration was 40 months (6-117 months).
When electromechanical dyssynchrony occurs in paediatric cases with CHD and developing heart failure, patients should be evaluated in terms of CRT to improve ventricular function. Alternative CRT therapy will be beneficial in these cases that do not improve clinically despite optimal medical treatment.
近年来，心脏再同步治疗（CRT）也开始应用于儿科和先天性心脏病（CHD）患者。本研究旨在评估 CRT 在 CHD 患儿中的疗效。
本研究纳入了 2010 年 1 月至 2020 年 1 月期间在我院儿科心脏病学诊所接受 CRT 治疗的 CHD 患者。系统回顾了患者的人口统计学资料、12 导联心电图、超声心动图、临床特征、管理策略和结局。
本研究人群包括在我院接受 CRT 治疗 10 年的 18 例 CHD 患者。中位年龄为 11 岁（2.2-18 岁），中位体重为 39kg（10-81kg）。13 例患者的左心室为系统心室，4 例患者的右心室为系统心室，1 例患者为单心室生理。CRT 植入的适应证如下：11 例患者为永久性起搏器功能障碍，4 例患者为左束支传导阻滞功能障碍，3 例患者为系统性心室功能障碍。CRT 植入技术包括心外膜（n = 13）、混合（n = 4）和经静脉（n = 1）方法。CRT 植入后 QRS 时限明显缩短（160 比 124ms，p < 0.05）。术后中位系统性心室射血分数（EF）明显升高（30 比 50%，p < 0.05）。14 例（78%）患者为应答者，2 例（11%）患者为超应答者，2 例（11%）患者为无应答者。1 例患者在随访期间死亡。中位随访时间为 40 个月（6-117 个月）。
当 CHD 患儿出现电机械不同步并发展为心力衰竭时，应评估患者是否适合 CRT 治疗以改善心室功能。对于尽管接受了最佳药物治疗但仍无临床改善的患者，替代 CRT 治疗将是有益的。
