Clinical InvestigationsCardiac resynchronization therapy improves the ventricular function of patients with Fontan physiology
Section snippets
Patients
Patient records at Boston Children's Hospital were queried from 2004 (when our echocardiography laboratory converted from analog to digital technology) to 2019. Patients with single ventricles palliated via the Fontan procedure who had ventricular pacemakers implanted (before, during, or after Fontan completion) and also had pre- and postdevice echocardiographic studies that permitted measurement of dP/dtic and the Tei index were included in the study. Patients who underwent CRT device
Patients
During the period under study, 23 patients with Fontan physiology received CRT. Of these, 17 patients had echocardiographic studies that permitted determination of the dP/dtic and the Tei index at all 3 time points. These 17 patients were the focus of this study. One patient received a heart transplant 2 months after the initiation of CRT, and another transferred care to another institution 3 months after initiation of CRT. These 2 patients therefore did not have a Late-Post measurement, but
Discussion
Our study differs from previous studies on the effect of CRT on patients with Fontan physiology in that the indices of ventricular function that were used were quantitative and were independent of ventricular anatomy or geometry. Our methodology can therefore, theoretically, provide more objective and reliable data concerning the effect of CRT in this population.
Not surprisingly, we found that the indices of ventricular function of both patient groups tended to be lower than those of Fontan
Limitations
This was a single-center, retrospective study. Consequently, the number of patients included in this study was small. Moreover, the indications for CRT implantation and the follow-up of patients receiving CRT or DCPM were not protocolized. Patients who were lost to follow-up or who did not have ongoing care at our institution following the initiation of pacemaker therapy could not be included in the study. In addition, although the time intervals between the echocardiographic measurements were
Conclusions
Quantitative assessments of ventricular function, using indices that are not confounded by complex cardiac anatomy, segmental wall motions abnormalities, or potentially inappropriate geometric assumptions, revealed that CRT is associated with preservation or improvement of ventricular function compared to standard DCPM in Fontan patients with high-grade AV block. For future studies of the effect of CRT upon the ventricular function of patients with Fontan circulations, these indices may offer
One-sentence summary
Assessments of ventricular function using quantitative echocardiographic indices that are not confounded by complex ventricular anatomy or potentially invalid geometric assumptions revealed that cardiac resynchronization therapy is associated with an improvement in ventricular function compared to standard dual-chamber pacemaker therapy in patients with Fontan physiology.
Declaration of competing interests
None declared.
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Cited by (11)
Indications for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease
2023, Cardiac Electrophysiology ClinicsTechniques for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease
2023, Cardiac Electrophysiology ClinicsCardiac Implantable Electronic Devices in the Fontan Patient
2022, Canadian Journal of CardiologyCitation Excerpt :Similarly, in the largest single-centre study of multisite pacing to date including 19 patients, only a tendency toward improved survival was noted with this approach.46 More recently however, using sensitive, quantitative indices of single-ventricle function (eg, dV/dT and Tei index), CRT outcomes, using multisite pacing for single-ventricle patients have been shown to be superior to conventional ventricular pacing.47 Such findings are encouraging and reinforce the notion that CRT is indeed beneficial for the vulnerable Fontan population and should be more widely considered for these patients when there is an expectation for chronic ventricular pacing.
Classic-Pattern Dyssynchrony Is Associated with Outcome in Patients with Fontan Circulation
2022, Journal of the American Society of EchocardiographyCitation Excerpt :Subsequent reports of CRT in single ventricles have been included in larger series of patients with CHD.34,35 Boston Children's Hospital reported 23 CRT implantations in Fontan-operated patients between 2004 and 2019, showing improved Tei index and dP/dt as an effect of CRT.36 Despite this literature, a German national registry study reported only two registered patients with Fontan completion who received CRT37 until 2018.
Declarations of interest: None.