Abstract 9908: Acute Hemodynamic Improvement During Dual Sites Pacing Study Does Not Predict the Late Hemodynamic and Functional Status by Cardiac Re-synchronization Therapy in Patients with a Right Ventricular Type Systemic Ventricle

Abstract

Background: Cardiac resynchronization therapy (CRT) has shown a reduced mortality as well as functional improvements in patients with refractory heart failure. However, data on CRT in patients with congenital heart disease (CHD) are limited. Objectives: This study aims to clarify the efficacy of CRT in CHD patients with various hemodynamic settings, especially a morphology of the systemic ventricle (SV). Methods: The study population consisted of 17 CHD patients (mean 22 ± 12.7 years old) who had been treated with CRT since 2006. We divided the patients into 3 groups based on types of the hemodymamics and the type of SV, i.e., 7 patients with left ventricle SV (sLV), 6 with right ventricle SV (sRV) after a biventricular repair, and 4 with the unbalanced SV single ventricular physiology (sBV). We evaluated the acute effect of CRT on hemodynamics and SV function before the device implantation and also assessed chronic (≥ 6 months) impact of CRT on the late outcome, including plasma brain natriuretic peptide level (BNP: pg/ml) and New York Heart Association (NYHA) functional class. Results: In all patients, the SV volume (ml/m2) (139 ± 41 to 117 ± 36) and BNP (353 ± 396 to 112 ± 102) decreased (p < 0.01 for both) with the improvement of NYHA functional class (2.1 ± 0.7 to 1.9 ± 0.8, p =0.04) 6 months after the CRT. Among the 3 groups, the sRV group did not show a late SV volume reduction despite the shortening of QRS width (198 ± 28 to 136 ± 19 ms, p =0.0005) and increase in SV peak dP/dt ( p =0.02) at the acute study, while the other 2 groups showed the acute and late hemodynamic improvement with the late SV volume reduction. Conclusions: The CRT improves late hemodynamic and functional status in sLV and sBV CHD patients with a dyssynchronized SV. However, an acute effect of CRT cannot guarantee the long-term benefit in sRV patients.