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Cardiac Resynchronization Therapy in Adult Patients with Repaired Tetralogy of Fallot and Left Ventricular Systolic Dysfunction
Author(s) -
MERCHANT FAISAL M.,
KELLA DANESH,
BOOK WENDY M.,
LANGBERG JONATHAN J.,
LLOYD MICHAEL S.
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12284
Subject(s) - medicine , ejection fraction , cardiology , cardiac resynchronization therapy , tetralogy of fallot , diastole , heart failure , end diastolic volume , stroke volume , heart disease , blood pressure
Background Although left ventricular (LV) systolic dysfunction is known to occur in adults with repaired Tetralogy of Fallot (TOF), the effects of cardiac resynchronization therapy (CRT) are not well characterized. Methods We retrospectively divided all patients with repaired TOF and impaired LV ejection fraction (LVEF ≤ 40%) undergoing CRT at our institution (n = 10) into two groups: de novo CRT (group A, n = 6) or upgrade from existing device (group B, n = 4). Echocardiograms were reviewed at baseline, medium‐term (>6 months post‐CRT), and long‐term follow‐up. CRT response was defined as reduction in LV end‐systolic volume (LVESV) ≥15% at medium term. Results Age at surgical repair was 13.1 ± 16.0 years, age at CRT was 44.4 ± 12.5 years, and baseline LVEF was 24.0 ± 10.5%. Group A demonstrated a preponderance of right ventricular (RV) conduction delay, whereas all patients in group B demonstrated RV pacing at baseline. At medium‐term follow‐up, patients in group A showed significant improvements in LVEF, LV end‐diastolic volume (LVEDV), and LVESV. Group B also demonstrated a significant improvement in LVEF with favorable trends in LV volumes. Of nine patients with complete data at medium term, eight showed evidence of CRT response. Average long‐term follow‐up was 53.4 ± 29.3 months. At long‐term follow‐up, LVEF, LVEDV, and LVESV remained numerically better than baseline, although the results were no longer significant. Conclusions Adult patients with repaired TOF and LV systolic dysfunction demonstrate significant medium‐term response to CRT, even among those with RV conduction delay. The long‐term impact of CRT in this population requires further characterization.