Long Term Efficacy and Safety of Cardiac Resynchronization Therapy in Adult Congenital Heart Disease Patients: A Single Center Cohort Study

• Published in: The American journal of cardiology Vol. 242; pp. 82 - 87
• Main Authors: Schamroth Pravda, Nili, Richter, Ilan, Brem, Ofir, Yehuda, Daniel, Rahat, Ori, Ofek, Hadas, Tal, Shir, Kornowski, Ran, Vig, Shahar, Buturlin, Kirill, Hirsch, Rafael, Golovchiner, Gregory
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2025; Elsevier Limited
• Subjects: Adult; adult congenital heart disease; Adults; Aged; Cardiac arrhythmia; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiomyopathy; Cardiovascular disease; Cohort analysis; Congenital diseases; Congestive heart failure; Coronary artery disease; Echocardiography; Effectiveness; Ejection fraction; Failure; Female; Follow-Up Studies; Heart Defects, Congenital - complications; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - therapy; Heart diseases; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - therapy; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hematoma; Humans; Infections; Male; Middle Aged; Morbidity; Patients; Pericarditis; Population; Prevention; Response rates; Retrospective Studies; Stroke Volume - physiology; Subgroups; Time Factors; Treatment Outcome; Ultrasonic imaging; Ventricle; heart failure; cardiac resynchronization therapy; adult congenital heart disease
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2025.01.011

•This study provides real-world evidence showing CRT is effective in ACHD patients, regardless of ventricular morphology or baseline ejection fraction.•CRT is beneficial as both a therapeutic and preventative treatment. Heart failure constitutes a major cause for morbidity amongst patients with adult congenital heart disease (ACHD). Cardiac resynchronization therapy (CRT) is a recommended therapeutic measure for patients with heart failure. Data on the efficacy and safety of CRT amongst patients with ACHD is limited. This study analyzed data from a retrospective cohort of patients with ACHD and implantation of CRT between 2015 and 2022. The primary outcome was echocardiographic response to CRT, defined as either: (1) an increase in systemic ventricular ejection fraction (EF) of ≥ 5% in patients with baseline EF <50% (therapeutic efficacy) or (2) maintenance of EF in patients with EF ≥ 50% (preventative efficacy). The outcomes were assessed by subgroups of systemic left or right ventricle ventricle. In a cohort of 45 patients, mean age was 54 ± 14 years, 26 patients had a systemic left ventricle (57.8%) and 19 patients had a systemic right ventricle (42.2%). The average follow-up was 5.2 ± 0.5 years. Primary outcome amongst patients with reduced EF at baseline was achieved in 69.0%; and in 92.3% amongst patients with preserved EF at baseline. There was no significant difference in the response to CRT as per systemic left or right ventricle (p = 0.15) or per baseline EF (p = 0.10). Complications occurred in 28.9% of patients. In conclusion, CRT appears to be effective in patients with ACHD in reducing rates of heart failure, regardless of baseline EF or systemic ventricle morphology. The percentage of patients with a safety outcome was relatively high and highlights the need for careful patient selection.