Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study-Reference-Cited by-同舟云学术

Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study

Published:2024-03 Issue:3 Volume:17 Page:
ISSN:1941-3149
Container-title:Circulation: Arrhythmia and Electrophysiology
language:en
Short-container-title:Circ: Arrhythmia and Electrophysiology

Author:

Ramdat Misier Nawin L.¹,Moore Jeremy P.²^ORCID,Nguyen Hoang H.³^ORCID,Lloyd Michael S.⁴^ORCID,Dubin Anne M.⁵^ORCID,Mah Douglas Y.⁶^ORCID,Czosek Richard J.⁷^ORCID,Khairy Paul⁸^ORCID,Chang Philip M.⁹^ORCID,Nielsen Jens C.¹⁰¹¹^ORCID,Aydin Alper¹²^ORCID,Pilcher Thomas A.¹³^ORCID,O’Leary Edward T.⁶^ORCID,Shivkumar Kalyanam²^ORCID,de Groot Natasja M.S.¹

Affiliation:

1. Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.).

2. Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.).

3. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (H.H.N.).

4. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.L.).

5. Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA (A.M.D.).

6. Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.).

7. Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children’s Hospital Medical Center, Cincinnati OH (R.J.C.).

8. Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal Quebec, Canada (P.K.).

9. Congenital Heart Center, University of Florida Health, Gainesville, FL (P.M.C.).

10. Department of Clinical Medicine, Aarhus University, Aarhus Denmark (J.C.N.).

11. Department of Cardiology, Aarhus University Hospital, Aarhus Denmark (J.C.N.).

12. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada (A.A.).

13. Division of Pediatric Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City UT (T.A.P.).

Abstract

BACKGROUND: A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot. METHODS: Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation. RESULTS: A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%–44%] at baseline to 42% [32%–50%] at early follow-up ( P <0.001) and remained improved from baseline thereafter ( P ≤0.002). The QRS duration decreased from 180 [160–205] ms at baseline to 152 [133–182] ms at early follow-up ( P <0.001) and remained decreased at intermediate and late follow-up ( P ≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point ( P ≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline ( P ≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%. CONCLUSIONS: In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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