60. Mid-term outcome of cardiac resynchronization therapy in pediatrics: single institution experience

Abstract

Cardiac resynchronization therapy (CRT) has become an increasingly important therapeutic option for patients (pts) to treat dyssynchrony associated moderate and severe heart failure. Few reports however, determined the beneficial effects of CRT in pediatrics and midterm outcome following this therapy. Our aim is to assess the mid-term outcomes of CRT in children with evidence of dyssynchrony associated heart failure. Cardiac resynchronization therapy is beneficial in treating congenital heart disease patients who have evidence of dyssynchrony associated heart failure. Retrospective review of 18 consecutive pediatric patients who underwent CRT at our institution between January 2002 and August 2011 Cardiac resynchronization pacemaker was implanted in 18 pts the majority of pts (14) with congenital heart disease. Fourteen pts had preexisting complete heart block and chronic right ventricular pacing. Epicardial left ventricular leads were implanted in all pts while the atrial and right ventricular leads approach varied according to the pt size and anatomy. Indication for CRT was symptomatic dilated cardiomyopathy with evidence of electrical and/or mechanical dyssynchrony demonstrated by M-mode, 3-D echo, or tissue Doppler. The median age of this cohort was 14 years (range 6 months–16 years), the median follow-up time was 7.2 years (range 1–10 years). Subjectively, 16 out of 18 pts reported symptomatic improvement with decreased hospitalizations. The left ventricular ejection fraction improved from mean of 27% (SD 13%) to mean of 50% (SD 13%) (P value <0.001). Additionally, cardiomegaly improved significantly in during follow up (P value <0.001). The QRS duration with CRT was less but the change is not significant (P value = 0.1) suggesting that electrical resynchronization is not a prerequisite for clinical improvement in this cohort. Children including those with congenital heart disease patients who have evidence of dyssynchrony associated heart failure appear to benefit from cardiac resynchronization therapy on the mid-term. Selection criteria should include the use of new technologies to demonstrate mechanical dyssynchrony beside other conventional indications of CRT. Further studies looking at long-term benefits of CRT in pediatric and CHD patients are needed.