08:40 〜 09:10
[III-IL-10] Cardiac resynchronization therapy in congenital heart disease
Cardiac resynchronization therapy in congenital heart disease
Jan Janoušek, Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
Cardiac resynchronization therapy (CRT) is an established treatment option for adult patients suffering from heart failure due to idiopathic or ischemic cardiomyopathy associated with electromechanical dyssynchrony. A limited evidence exists suggests efficacy of CRT in patients with congenital heart disease (CHD). Due to the heterogeneity of structural and functional substrates CRT implantation techniques are different with a prevailing thoracotomy or hybrid approach. Efficacy of CRT in CHD seems to depend on the anatomy of the systemic ventricle with best results achieved in systemic left ventricular patients upgraded to CRT from conventional pacing. Indications to CRT in patients with CHD have been recently reviewed in the PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease. They include patients with systemic left, right and single ventricular anatomy along with electromechanical dyssynchrony caused by bundle branch block or conventional ventricular pacing. Due to lack of randomized prospective studies the recommendations are based mostly on C level of evidence. Despite many differences CRT seems to offer a similar benefit as to adult patients with idiopathic or ischemic cardiomyopathy and should be considered whenever electromechanical dyssynchrony is encountered along with heart failure.
Jan Janoušek, Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
Cardiac resynchronization therapy (CRT) is an established treatment option for adult patients suffering from heart failure due to idiopathic or ischemic cardiomyopathy associated with electromechanical dyssynchrony. A limited evidence exists suggests efficacy of CRT in patients with congenital heart disease (CHD). Due to the heterogeneity of structural and functional substrates CRT implantation techniques are different with a prevailing thoracotomy or hybrid approach. Efficacy of CRT in CHD seems to depend on the anatomy of the systemic ventricle with best results achieved in systemic left ventricular patients upgraded to CRT from conventional pacing. Indications to CRT in patients with CHD have been recently reviewed in the PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease. They include patients with systemic left, right and single ventricular anatomy along with electromechanical dyssynchrony caused by bundle branch block or conventional ventricular pacing. Due to lack of randomized prospective studies the recommendations are based mostly on C level of evidence. Despite many differences CRT seems to offer a similar benefit as to adult patients with idiopathic or ischemic cardiomyopathy and should be considered whenever electromechanical dyssynchrony is encountered along with heart failure.