Left ventricular dysfunction after cardiac resynchronization therapy in congenital heart disease patients with a failing systemic right ventricle.
BACKGROUND
Cardiac resynchronization therapy is rapidly emerging as an effective strategy for managing ventricular dysfunction and heart failure associated with congenital heart disease. Indications for therapy, optimal lead placement, and late outcomes are however lacking.


METHODS
We present three patients, one with Mustard procedure and two with congenitally corrected transposition of great arteries, who developed subpulmonic ventricular dysfunction 3-6 months after biventricular pacing +/- implantable cardioverter defibrillator implantation, despite initial favorable result of resynchronization therapy. Possible factors for adverse outcome are relatively high pacing rate, unfavorable alteration of torsional contraction, and increased atrioventricular valve regurgitation due to suboptimal placement of larger diameter defibrillation leads.


RESULTS
Careful evaluation of patients, particularly indications for therapy, need to be rigorous; assessment of hemodynamic response at the time of implant and appropriate programming may improve the effectiveness of cardiac resynchronization therapy (CRT) in this patient population.


CONCLUSIONS
Our case series emphasizes the need for a registry in the absence of randomized controlled trials, in order to identify patients who benefit most from CRT, and, importantly, recognize subgroups that respond poorly.
Kiesewetter
Christoph
C
Wessex Adult Congenital Heart Unit, Wessex Cardiothoracic Centre, Southampton General Hospital, Wessex, United Kingdom.
Michael
Kevin
K
Morgan
John
J
Veldtman
Gruschen R
GR
D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000503:physiopathology*