Cardiac Resynchronization Therapy in Congenital Heart Disease Patients with Systemic Right Ventricle

Etienne Jacquemart (1) , Nicolas Combes (2) , Guillaume Duthoit (3) , Francis Bessière (4) , Magalie Ladouceur (1) , Laurence Iserin (5) , Mikael Laredo (3) , Charlène Bredy (6) , Alice Maltret (2) , Sylvie Di Filippo (4) , Sébastien Hascoët (2) , Jean Luc Pasquié (7, 6) , Eloi Marijon (1, 5) , Victor Waldmann (5)

1 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
2 Hôpital Marie-Lannelongue
3 CHU Pitié-Salpêtrière [AP-HP]
4 Hôpital Louis Pradel [CHU - HCL]
5 HEGP - Hôpital Européen Georges Pompidou [APHP]
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]

Background: Although patients with systemic right ventricle (SRV) represent a significant proportion of patients with congenital heart disease (CHD) implanted with cardiac resynchronization therapy (CRT), there are limited and conflicting data in this specific patient group.Objective: We aimed to analyze outcomes of patients with SRV implanted with a CRT device.Methods: Data were analyzed from an observational, retrospective, multicenter cohort study including all patients with CHD implanted with a CRT device from 6 French centers from 2004 to 2020. Response to CRT was defined as an increase in systemic ventricular ejection fraction of ≥10% and/or an improvement in New York Heart Association functional class by at least 1 grade.Results: A total of 85 patients with CHD were enrolled (mean age 39.8 ± 20.0 years; 55 [64.7%] males; 25 defibrillators [29.4%]), including 31 patients with SRV (36.5%) (mean age 43.9 ± 19.8 years; 16 [51.6%] males). The mean change in QRS duration after implantation was similar as compared with patients with systemic left ventricle (−46 ± 26 ms vs −35 ± 32 ms; P = .16). During a mean follow-up of 5.1 ± 3.5 years, late complications included 2 lead dysfunctions (6.5%), 3 CRT-related infections (9.7%), and 1 inappropriate implantable cardioverter-defibrillator shock (3.2%). The proportion of CRT responders at 6, 12, and 24 months were 82.6%, 80.0%, and 77.8% in patients with SRV vs 66.7%, 64.3%, and 69.6% in patients with systemic left ventricle (P = NS).Conclusion: In this multicenter cohort, one-third of patients with CHD implanted with a CRT device had SRV. CRT in patients with SRV was associated with a high rate of responders, comparable to that of patients with systemic left ventricle.

Mots clés: Cardiac resynchronization therapy; Congenital heart disease; Systemic right ventricle; Transposition of the great arteries; Heart failure

Domaines: Cardiologie et système cardiovasculaire

Etienne Jacquemart, Nicolas Combes, Guillaume Duthoit, Francis Bessière, Magalie Ladouceur, et al.. Cardiac Resynchronization Therapy in Congenital Heart Disease Patients with Systemic Right Ventricle. Heart Rhythm, 2022, 19 (4), pp.658-666. ⟨10.1016/j.hrthm.2021.11.032⟩. ⟨hal-03470829⟩