Baba Shigehito, Miyazaki Aya, Watanabe Toru, Shiraishi Shuichi, Saitoh Akihiko
Department of Pediatrics, Niigata University, 757 Asahimachidori Ichibancho, Niigata City, Niigata 951-8510, Japan.
Department of Adult Congenital Heart Disease and Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka 430-8558, Japan.
Eur Heart J Case Rep. 2024 Nov 14;8(12):ytae607. doi: 10.1093/ehjcr/ytae607. eCollection 2024 Dec.
Evidence regarding cardiac resynchronization therapy (CRT) for congenitally corrected transposition of the great arteries (ccTGA) is insufficient. The timing to perform CRT and optimal pacing sites have not been systematically studied. We performed CRT for ccTGA with a complete atrioventricular block (CAVB) by pacing the dorsal site of right ventricular inflow (dRVI) and anterior RV outflow tract (aRVOT).
We examined a man aged 19 with ccTGA (S.L.L) and Ebstein anomaly, who developed CAVB at 19. We decided to implant CRT rather than a conventional pacemaker for preventing right ventricular (RV) dysfunction. At first, we implanted transvenous pacing leads on the right atrium and dRVI via the coronary sinus. During dRVI pacing, the most delayed contraction site was the aRVOT by the echocardiographic speckle tracking and the electrophysiological study. Accordingly, we implanted additional epicardial lead in the aRVOT and completed the implantation of CRT. After the CRT, the QRS duration was shortened from 187 to 132 ms and RV ejection fraction (RVEF) by right ventriculography increased from 35% to 42%.The distance between two ventricular leads (dRVI and aRVOT) was 93% with 85% of longitudinal and radial direction in the RV. The effective CRT in this case was characterized by covering RV in the longitudinal and radial direction.
Separate two-point pacing on the dRVI and aRVOT, which assists the contraction in the longitudinal and radial dimension, is considered a potential position for CRT pacing and an effective method in ccTGA.
关于先天性矫正型大动脉转位（ccTGA）的心脏再同步治疗（CRT）的证据不足。进行CRT的时机和最佳起搏部位尚未得到系统研究。我们通过对右心室流入道背侧部位（dRVI）和右心室流出道前部（aRVOT）进行起搏，对患有完全性房室传导阻滞（CAVB）的ccTGA患者实施了CRT。
我们检查了一名19岁患有ccTGA（S.L.L）和埃布斯坦畸形的男性，他在19岁时出现了CAVB。我们决定植入CRT而不是传统起搏器，以预防右心室（RV）功能障碍。起初，我们经静脉将起搏导线植入右心房和通过冠状窦植入dRVI。在dRVI起搏期间，通过超声心动图斑点追踪和电生理研究发现，最延迟收缩的部位是aRVOT。因此，我们在aRVOT植入了额外的心外膜导线并完成了CRT植入。CRT植入后，QRS波时限从187毫秒缩短至132毫秒，右心室造影显示右心室射血分数（RVEF）从35%增加到42%。两根心室导线（dRVI和aRVOT）之间的距离为93%，在右心室纵向和径向方向上占85%。该病例中有效的CRT特点是在纵向和径向上覆盖右心室。
在dRVI和aRVOT进行单独的两点起搏，可在纵向和径向上辅助收缩，被认为是CRT起搏的潜在位置和ccTGA的有效方法。
