title: Pediatric Dilated Cardiomyopathy Patients Do Not Meet Traditional Cardiac Resynchronization Criteria.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is an effective device-based intervention for adults with heart failure (HF) with specific indications, based on large, multicenter randomized clinical trials. The criteria for CRT in adult HF include significant symptoms, ventricular systolic dysfunction, prolonged QRS duration, and left bundle branch block (LBBB) pattern on electrocardiogram (ECG). Despite having less data, CRT is also being widely utilized in children with HF. The shortage of evidence-based CRT criteria in pediatrics prompted us to review a cohort of children with dilated cardiomyopathy and evaluate their potential eligibility for CRT using the traditional adult criteria.
  
  
  METHODS
  Single-center data of all pediatric patients with dilated cardiomyopathy were extracted from the heart failure registry and retrospectively reviewed. Patients who had at least 2 separate visits that included HF scoring, electrocardiogram, and echocardiogram were included. Patients who were ventricular paced were excluded.
  
  
  RESULTS
  Data for 52 patients meeting inclusion criteria were analyzed. The mean ejection fraction was 25% on the first clinical evaluation and 27% on the second visit. No patient and 2 patients met the adult criteria for prolonged QRS on the first and second encounters, respectively. No patients had an LBBB pattern on ECG.
  
  
  CONCLUSIONS
  None of the pediatric HF patients in our study met the published Class I criteria for CRT device therapy in adults. These findings suggest that extrapolation of adult HF data to pediatrics is not sufficient for CRT criteria. Specific guidelines for device implantation in children must be based on scientific investigation including pediatric clinical trials.
authors.affiliation: Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Ofer
authors.initials: O
authors.lastname: Schiller
authors.affiliation: Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Niti
authors.initials: N
authors.lastname: Dham
authors.affiliation: Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: E Anne
authors.initials: EA
authors.lastname: Greene
authors.affiliation: Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Deneen M
authors.initials: DM
authors.lastname: Heath
authors.affiliation: Department of Cardiology, Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Alexander
authors.affiliation: Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Charles I
authors.initials: CI
authors.lastname: Berul
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004219:District of Columbia; D004452:Echocardiography; D004562:Electrocardiography; D004608:Eligibility Determination; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: cardiac resynchronization therapy; dilated cardiomyopathy; echocardiogram; electrocardiogram; left bundle branch block; pediatrics