☆ 4.6 Article

Haemodynamic consequences of targeted single- and dual-site right ventricular pacing in adults with congenital heart disease undergoing surgical pulmonary valve replacement

EUROPACE (2015)

Journal

EUROPACE

Volume 17, Issue 2, Pages 274-280

Publisher

OXFORD UNIV PRESS

DOI: 10.1093/europace/euu281

Keywords

Congenital heart disease; Resynchronization; Right ventricle; Electroanatomic map

Funding

Department of Health's NHIR Biomedical Research Centres Scheme
University College London
Medical Research Council [MR/K006584/1] Funding Source: researchfish

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Abstract

Aims The purpose of this study was to create an epicardial electroanatomic map of the right ventricle (RV) and then apply post-operative-targeted single-and dual-site RV temporary pacing with measurement of haemodynamic parameters. Cardiac resynchronization therapy is an established treatment for symptomatic left ventricular (LV) dysfunction. In congenital heart disease, RV dysfunction is a common cause of morbidity-little is known regarding the potential benefits of CRT in this setting. Methods and results Sixteen adults (age = 32 +/- 8 years; 6 M, 10 F) with right bundle branch block (RBBB) and repaired tetralogy of Fallot (n = 8) or corrected congenital pulmonary stenosis (n = 8) undergoing surgical pulmonary valve replacement (PVR) for pulmonary regurgitation underwent epicardial RV mapping and haemodynamic assessment of random pacing configurations including the site of latest RV activation. The pre-operative pulmonary regurgitant fraction was 49 +/- 10%; mean LV end-diastolic volume (EDV) 85 +/- 19 mL/min/m(2) and RVEDV 183 +/- 89 mL/min/m(2) on cardiac magnetic resonance imaging. The mean pre-operative QRS duration is 136 +/- 26 ms. The commonest site of latest activation was the RV free wall and DDD pacing here alone or combined with RV apical pacing resulted in significant increases in cardiac output (CO) vs. AAI pacing (P < 0.01 all measures). DDDRV alternative site pacing significantly improved CO by 16% vs. AAI (P = 0.018), and 8.5% vs. DDDRV apical pacing (P = 0.02). Conclusion Single-site RV pacing targeted to the region of latest activation in patients with RBBB undergoing PVR induces acute improvements in haemodynamics and supports the concept of 'RV CRT'. Targeted pacing in such patients has therapeutic potential both post-operatively and in the long term.

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Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study

Rohit K. Kharbanda, Jeremy P. Moore, Michael S. Lloyd, Robert Galotti, Ad J. J. C. Bogers, Yannick J. H. J. Taverne, Malini Madhavan, Christopher J. McLeod, Anne M. Dubin, Douglas Y. Mah, Philip M. Chang, Anna N. Kamp, Jens C. Nielsen, Alper Aydin, Ronn E. Tanel, Maully J. Shah, Thomas Pilcher, Reinder Evertz, Paul Khairy, Reina B. Tan, Richard J. Czosek, Kalyanam Shivkumar, Natasja M. S. de Groot

Summary: This international multicenter study investigated the outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and identified predictors for congestive heart failure readmissions and mortality. The study found that CRT significantly improved functional class and QRS duration in patients with pre-CRT ventricular pacing who underwent an upgrade to a CRT device. However, no beneficial change was observed in patients who underwent de novo CRT. A quarter of all patients were readmitted for heart failure and the mortality rate was 21.3%.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2022)