1
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Zimmerman FJ, Gamboa D. Techniques for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:447-455. [PMID: 37865518 DOI: 10.1016/j.ccep.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Cardiac resynchronization therapy (CRT) for congenital heart disease has shown promising suucess as an adjunct to medical therapy for heart failure. While cardiac conduction defects and need for ventricular pacing are common in congential heart disease, CRT indications, techniques and long term outcomes have not been well establaished. This is a review of the techniques nad short term outcomes of CRT for the following complex congenital heart disease conditions: single ventricle physiology, systemic right ventricle, and the subpulmonic right ventricle.
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Affiliation(s)
- Frank J Zimmerman
- Advocate Children's Heart Institute, 4440 West 95th Street, Oak Lawn, IL 60453, USA.
| | - David Gamboa
- Advocate Children's Heart Institute, 4440 West 95th Street, Oak Lawn, IL 60453, USA
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2
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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3
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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4
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Barracano R, Brida M, Guarguagli S, Palmieri R, Diller GP, Gatzoulis MA, Wong T. Implantable cardiac electronic device therapy for patients with a systemic right ventricle. Heart 2020; 106:1052-1058. [PMID: 32269130 DOI: 10.1136/heartjnl-2019-316202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022] Open
Abstract
The systemic right ventricle (SRV), defined as the morphological right ventricle supporting the systemic circulation, is relatively common in congenital heart disease (CHD). Our review aimed at examining the current evidence, knowledge gaps and technical considerations regarding implantable cardiac electronic device therapy in patients with SRV. The risk of sinus node dysfunction (SND) after atrial switch repair and/or complete heart block in congenitally corrected transposition of great arteries requiring permanent pacing increases with age. Similar to acquired heart disease, indication for pacing includes symptomatic bradycardia, SND and high degree atrioventricular nodal block. Right ventricular dysfunction and heart failure also represent important complications in SRV patients. Cardiac resynchronisation therapy (CRT) has been proposed to improve systolic function in SRV patients, although indications for CRT are not well defined and its potential benefit remains uncertain. Amongst adult CHD, patients with SRV are at the highest risk for sudden cardiac death (SCD). Nevertheless, risk stratification for SCD is scarce in this cohort and implantable cardioverter-defibrillator indication is currently limited to secondary prevention. Vascular access and the incidence of device-related complications, such as infections, inappropriate shocks and device system failure, represent additional challenges to implantable cardiac electronic device therapy in patients with SRV. A multidisciplinary approach with tertiary expertise and future collaborative research are all paramount to further the care for this challenging nonetheless ever increasing cohort of patients.
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Silvia Guarguagli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Rosalinda Palmieri
- Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tom Wong
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
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5
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Friedberg MK. Another Step in the Right Direction: Resynchronizing the Dyssynchronous Right Ventricle Improves Its Efficiency and Function. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.117.006905. [PMID: 28877887 DOI: 10.1161/circimaging.117.006905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark K Friedberg
- From the Labatt Family Heart Centre, Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics, University of Toronto, Ontario, Canada.
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6
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Hill AC, Silka MJ, Bar-Cohen Y. Cardiac Resynchronization Therapy in Pediatrics. J Innov Card Rhythm Manag 2018; 9:3256-3264. [PMID: 32477817 PMCID: PMC7252792 DOI: 10.19102/icrm.2018.090804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/27/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has proven to be a powerful and effective tool in the treatment of adults with severe dilated or ischemic cardiomyopathy. A substantial portion of the adult heart failure population has severely depressed systolic function, heart failure symptoms, QRS prolongation, and left bundle branch block. Indications for CRT in adults are commonly focused on these characteristics. However, pediatric patients represent a heterogeneous group with many etiologies of heart failure and anatomic variants, with most of them not fitting the typical adult CRT criteria. The heterogeneity of the pediatric population has hindered the identification of ideal candidates for CRT, but initial experience with CRT in various groups of pediatric patients has been encouraging. This article reviews indications for and outcomes of CRT in pediatric and congenital heart disease patients.
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Affiliation(s)
- Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael J Silka
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yaniv Bar-Cohen
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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7
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Anjewierden S, Aziz PF. Resynchronization Therapy for Patients with Congenital Heart Disease: Are We Ready for Prime Time? Curr Cardiol Rep 2018; 20:75. [DOI: 10.1007/s11886-018-1015-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Marino BS, Tabbutt S, MacLaren G, Hazinski MF, Adatia I, Atkins DL, Checchia PA, DeCaen A, Fink EL, Hoffman GM, Jefferies JL, Kleinman M, Krawczeski CD, Licht DJ, Macrae D, Ravishankar C, Samson RA, Thiagarajan RR, Toms R, Tweddell J, Laussen PC. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e691-e782. [PMID: 29685887 DOI: 10.1161/cir.0000000000000524] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care.
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9
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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Janoušek J, Kovanda J, Ložek M, Tomek V, Vojtovič P, Gebauer R, Kubuš P, Krejčíř M, Lumens J, Delhaas T, Prinzen F. Pulmonary Right Ventricular Resynchronization in Congenital Heart Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006424. [DOI: 10.1161/circimaging.117.006424] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/22/2017] [Indexed: 02/04/2023]
Abstract
Background—
Electromechanical discoordination may contribute to long-term pulmonary right ventricular (RV) dysfunction in patients after surgery for congenital heart disease. We sought to evaluate changes in RV function after temporary RV cardiac resynchronization therapy.
Methods and Results—
Twenty-five patients aged median 12.0 years after repair of tetralogy of Fallot and similar lesions were studied echocardiographically (n=23) and by cardiac catheterization (n=5) after primary repair (n=4) or after surgical RV revalvulation for significant pulmonary regurgitation (n=21). Temporary RV cardiac resynchronization therapy was applied in the presence of complete right bundle branch block by atrial-synchronized RV free wall pacing in complete fusion with spontaneous ventricular depolarization using temporary electrodes. The q-RV interval at the RV free wall pacing site (mean 77.2% of baseline QRS duration) confirmed pacing from a late activated RV area. RV cardiac resynchronization therapy carried significant decrease in QRS duration (
P
<0.001) along with elimination of the right bundle branch block QRS morphology, increase in RV filling time (
P
=0.002), pulmonary artery velocity time integral (
P
=0.006), and RV maximum +dP/dt (
P
<0.001), and decrease in RV index of myocardial performance (
P
=0.006). RV mechanical synchrony improved: septal-to-lateral RV mechanical delay decreased (
P
<0.001) and signs of RV dyssynchrony pattern were significantly abolished. RV systolic stretch fraction reflecting the ratio of myocardial stretching and contraction during systole diminished (
P
=0.001).
Conclusions—
In patients with congenital heart disease and right bundle branch block, RV cardiac resynchronization therapy carried multiple positive effects on RV mechanics, synchrony, and contraction efficiency.
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Affiliation(s)
- Jan Janoušek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Jan Kovanda
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Ložek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Viktor Tomek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Pavel Vojtovič
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Roman Gebauer
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Peter Kubuš
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Krejčíř
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Joost Lumens
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Tammo Delhaas
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Frits Prinzen
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
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11
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Paech C, Dähnert I, Riede FT, Wagner R, Kister T, Nieschke K, Wagner F, Gebauer RA. QRS Width as a Predictor of Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation. Pediatr Cardiol 2017. [PMID: 28631207 DOI: 10.1007/s00246-017-1658-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent data showed a right ventricular dyssynchrony in patients with tetralogy of Fallot (TOF). Percutaneous pulmonary valve implantation (PPVI) has become an important procedure to treat a pulmonary stenosis and/or regurgitation of the right ventricular outflow tract in these patients. Despite providing good results, there is still a considerable number of nonresponders to PPVI. The authors speculated that electrical dysfunction of the right ventricle plays an underestimated role in the outcome of patients after PPVI. This study aimed to investigate the influence of right ventricular electrical dysfunction, i.e., right bundle branch block (RBBB) on the RV remodeling after PPVI. The study included consecutive patients after correction of TOF with or without RBBB, who had received a PPVI previously at the Heart Center of the University of Leipzig, Germany during the period from 2012 to 2015. 24 patients were included. Patients without RBBB, i.e., with narrow QRS complexes pre-intervention, had significantly better RV function and had smaller right ventricular volumes. Patients with pre-interventionally QRS width below 150 ms showed a post-interventional remodeling of the right ventricle with the decreasing RV volumes (p = 0.001). The parameters of LV function and volume as well as RV ejection fraction remained unaffected by RBBB. The presented data indicate that the QRS width seems to be a valuable parameter in the prediction of right ventricular remodeling after PPVI, as it represents both electrical and mechanical functions of the right ventricle and may serve as an additional parameter for optimal timing of a PPVI.
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Affiliation(s)
- C Paech
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - I Dähnert
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - F T Riede
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - R Wagner
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - T Kister
- Department for Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - K Nieschke
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - F Wagner
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - R A Gebauer
- Department for Pediatric Cardiology, University of Leipzig- HELIOS Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
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12
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Cecchin F, Halpern DG. Cardiac Arrhythmias in Adults with Congenital Heart Disease: Pacemakers, Implantable Cardiac Defibrillators, and Cardiac Resynchronization Therapy Devices. Card Electrophysiol Clin 2017; 9:319-328. [PMID: 28457245 DOI: 10.1016/j.ccep.2017.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implanting cardiac rhythm medical devices in adults with congenital heart disease requires training in congenital heart disease. The techniques and indications for device implantation are specific to the anatomic diagnosis and state of disease progression. It often requires a team of physicians and is best performed at a specialized adult congenital heart center.
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Affiliation(s)
- Frank Cecchin
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - Daniel G Halpern
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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13
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Vojtovič P, Kučera F, Kubuš P, Gebauer R, Matějka T, Tláskal T, Ložek M, Kovanda J, Janoušek J. Acute right ventricular resynchronization improves haemodynamics in children after surgical repair of tetralogy of Fallot. Europace 2017; 20:323-328. [DOI: 10.1093/europace/euw414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/01/2016] [Indexed: 11/13/2022] Open
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14
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Sanatani S, Cunningham T, Khairy P, Cohen MI, Hamilton RM, Ackerman MJ. The Current State and Future Potential of Pediatric and Congenital Electrophysiology. JACC Clin Electrophysiol 2017; 3:195-206. [PMID: 29759513 DOI: 10.1016/j.jacep.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 10/19/2022]
Abstract
Pediatric electrophysiologists specialize in the diagnosis and treatment of rhythm abnormalities in pediatric, congenital heart disease, and inherited arrhythmia syndrome patients. The field originated out of the unique knowledge base that rhythm management in young patients required. In the 1970s, pediatric electrophysiology was recognized as a distinct cardiac subspecialty and it has evolved rapidly since that time. Despite the considerable growth in personnel, technology, and complexity that the field has undergone, further opportunities to progress pediatric electrophysiology exist. In this review, we highlight some of the clinical focus of pediatric and adult congenital electrophysiologists to date and identify areas within this specialty where the pediatric and congenital electrophysiology community could come together in order to drive improvements in rhythm management for patients.
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Affiliation(s)
- Shubhayan Sanatani
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
| | - Taylor Cunningham
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Mitchell I Cohen
- Phoenix Children's Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Robert M Hamilton
- Division of Cardiology, The Labatt Heart Centre, The Hospital for Sick Children, and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, Minnesota
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15
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Friedberg MK, Schwartz SM, Zhang H, Chiu-Man C, Manlhiot C, Ilina MV, Arsdell GV, Kirsh JA, McCrindle BW, Stephenson EA. Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: Results of a randomized clinical trial. Heart Rhythm 2017; 14:240-247. [DOI: 10.1016/j.hrthm.2016.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 10/20/2022]
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16
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Matthaios I, Kaladaridou A, Skaltsiotes E, Agrios J, Antoniou A, Georgiopoulos G, Papadopoulou E, Pamboucas C, Toumanidis S. Acute Haemodynamic and Echocardiographic Effects of Multiple Configurations of Left Ventricular Pacing Sites in Acute Myocardial Infarction: Experimental Study. Heart Lung Circ 2016; 26:383-394. [PMID: 27670586 DOI: 10.1016/j.hlc.2016.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left ventricular (LV) pacing is unsuccessful in a significant number of patients, mainly due to sub-optimal LV pacing location. Nevertheless, data about the impact of different pacing sites on LV function in ischaemic myocardium are scarce. The purpose of this study was to investigate the effect of combinations of alternative LV pacing sites on LV mechanics after experimental acute anterior myocardial infarction (AMI), in order to define the optimal configuration. METHODS Atrioventricular epicardial pacing at alternative pacing sites was performed in 16 healthy pigs simultaneously, after experimental AMI. Standard right ventricular (RV) apical pacing was combined with: i) LV apex lateral wall; ii) LV basal posterior wall; iii) LV basal anterior wall, and; iv) LV basal anterior wall + LV basal posterior wall. Moreover the pacing configurations of, v) LV basal posterior wall + LV apex lateral wall; vi) LV basal posterior wall + LV basal anterior wall, and; vii) LV basal anterior wall + LV apex lateral wall were also investigated. Haemodynamic parameters, together with classic and novel echocardiographic indices were used, to evaluate the effect of each pacing combination. A speckle tracking technique using EchoPAC software was used. RESULTS After AMI, the pacing combination of LV apex lateral wall and LV basal posterior wall had the most favourable effect on LV function, leading to similar haemodynamic and torsional effects with sinus rhythm (all variables p>0.05). CONCLUSIONS In pig hearts after AMI, the combination of pacing LV apex lateral wall and LV basal posterior wall managed to maintain the LV function at a level comparable to the sinus rhythm.
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Affiliation(s)
- I Matthaios
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - A Kaladaridou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - E Skaltsiotes
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - J Agrios
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - A Antoniou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - G Georgiopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - E Papadopoulou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - C Pamboucas
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - S Toumanidis
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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17
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Janoušek J, Kubuš P. Cardiac resynchronization therapy in congenital heart disease. Herzschrittmacherther Elektrophysiol 2016; 27:104-109. [PMID: 27225165 DOI: 10.1007/s00399-016-0433-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment option for adult patients suffering heart failure due to idiopathic or ischemic cardiomyopathy associated with electromechanical dyssynchrony. There is limited evidence suggesting similar efficacy of CRT in patients with congenital heart disease (CHD). Due to the heterogeneity of structural and functional substrates, CRT implantation techniques are different with a thoracotomy or hybrid approach prevailing. Efficacy of CRT in CHD seems to depend on the anatomy of the systemic ventricle with best results achieved in systemic left ventricular patients upgraded to CRT from conventional pacing. Indications for CRT in patients with CHD were recently summarized in the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS) Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease and are presented in the text.
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Affiliation(s)
- Jan Janoušek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V úvalu 84, 15006, Prague, Czech Republic.
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V úvalu 84, 15006, Prague, Czech Republic
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18
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Brissaud O, Botte A, Cambonie G, Dauger S, de Saint Blanquat L, Durand P, Gournay V, Guillet E, Laux D, Leclerc F, Mauriat P, Boulain T, Kuteifan K. Experts' recommendations for the management of cardiogenic shock in children. Ann Intensive Care 2016; 6:14. [PMID: 26879087 PMCID: PMC4754230 DOI: 10.1186/s13613-016-0111-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts’ recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations’ assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.
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Affiliation(s)
- Olivier Brissaud
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Astrid Botte
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Gilles Cambonie
- Département de Pédiatrie Néonatale et Réanimations, Pôle Hospitalo-Universitaire Femme-Mère-Enfant, Hôpital Arnaud-de-Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295, Montpellier Cedex 5, France
| | - Stéphane Dauger
- Réanimation et Surveillance Continue Pédiatriques, Pôle de Pédiatrie Médicale, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Laure de Saint Blanquat
- Service de Réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Philippe Durand
- Réanimation Pédiatrique, AP-HP, CHU Kremlin Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Véronique Gournay
- Service de Cardiologie Pédiatrique, CHU de Nantes, 44093, Nantes Cedex, France
| | - Elodie Guillet
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Daniela Laux
- Pôle des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133, Avenue de la Résistance, 92350, Le Plessis-Robinson, France
| | - Francis Leclerc
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Philippe Mauriat
- Service de Cardiologie Pédiatrique et Congénitale, Hôpital Haut-Lévèque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Thierry Boulain
- Service de Réanimation Polyvalente, Hôpital de La Source, Centre Hospitalier Régional Orléans, 45067, Orléans, France
| | - Khaldoun Kuteifan
- Service de Réanimation Médicale, Hôpital Émile-Muller, 68070, Mulhouse, France
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19
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Abstract
Extrapolating cardiac resynchronization therapy (CRT) to pediatric patients with heart failure has at times been difficult given the heterogeneity of pediatric cardiomyopathies, varying congenital heart disease (CHD) substrates, and the fact that most pediatric heart failure patients have right bundle branch block (RBBB) as opposed to LBBB. Yet, despite these limitations a number of multi-center retrospective studies in North America and Europe have identified some data to suggest that certain sub-populations tend to respond positively to CRT. In order to address some of the heterogeneity it is helpful to subdivide pediatric and young adult patients with CHD into four potential groups: (1) CRT for chronic RV pacing, (2) dilated cardiomyopathies, (3) pulmonary right ventricles, and (4) systemic right ventricles. The chronic RV paced group, especially long-standing RV apical pacing, with ventricular dyssynchrony has consistently shown to be the group that best responds to a proactive resynchronization course. CRT therapy in pulmonary right ventricles such as post-op tetralogy of Fallot have shown some promise and may be considered especially if there is evidence of concomitant left ventricular dysfunction with an electrical dyssynchrony. Patients with systemic right ventricles such as post-atrial baffle surgery or congenitally corrected transposition reportedly do well with CRT in the presence of both inter-ventricular and intra-ventricular dyssynchrony. There is little doubt that moving forward to best way to identify which pediatric patients with heart failure will respond to CRT, will require a collaborative effort between the electrophysiologist and the echocardiographer to identify appropriate candidates with electrical and mechanical dyssynchrony.
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20
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Miyazaki A, Sakaguchi H, Kagisaki K, Tsujii N, Matsuoka M, Yamamoto T, Hoashi T, Noda T, Ohuchi H. Optimal pacing sites for cardiac resynchronization therapy for patients with a systemic right ventricle with or without a rudimentary left ventricle. Europace 2015; 18:100-12. [DOI: 10.1093/europace/euu401] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/19/2014] [Indexed: 11/14/2022] Open
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21
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Ceresnak SR, Perera JL, Motonaga KS, Avasarala K, Malloy-Walton L, Hanisch D, Punn R, Maeda K, Reddy VM, Doan LN, Kirby K, Dubin AM. Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children. Heart Rhythm 2015; 12:111-6. [DOI: 10.1016/j.hrthm.2014.09.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Indexed: 11/26/2022]
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22
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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23
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KARPAWICH PETERP, SINGH HARINDER, ZELIN KATHLEEN. Optimizing Paced Ventricular Function in Patients with and without Repaired Congenital Heart Disease by Contractility-Guided Lead Implant. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:54-62. [DOI: 10.1111/pace.12521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/08/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- PETER P. KARPAWICH
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
| | - HARINDER SINGH
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
| | - KATHLEEN ZELIN
- Section of Cardiology; Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit Michigan
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24
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PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: Executive Summary. Heart Rhythm 2014. [DOI: 10.1016/j.hrthm.2014.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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25
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Havalad V, Cabreriza SE, Cheung EW, Aponte-Patel L, Wang A, Cheng B, Wang DY, Silver E, Bacha EA, Spotnitz HM. Optimized multisite ventricular pacing in postoperative single-ventricle patients. Pediatr Cardiol 2014; 35:1213-9. [PMID: 24827078 PMCID: PMC5706648 DOI: 10.1007/s00246-014-0918-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/25/2014] [Indexed: 11/28/2022]
Abstract
Ventricular dyssynchrony is associated with morbidity and mortality after palliation of a single ventricle. The authors hypothesized that resynchronization with optimized temporary multisite pacing postoperatively would be safe, feasible, and effective. Pacing was assessed in the intensive care unit within the first 24 h after surgery. Two unipolar atrial pacing leads and four bipolar ventricular pacing leads were placed at standardized sites intraoperatively. Pacing was optimized to maximize mean arterial pressure. The protocol tested 11 combinations of the 4 different ventricular lead sites, 6 atrioventricular delays (50-150 ms), and 14 intraventricular delays. Optimal pacing settings were thus determined and ultimately compared in four configurations: bipolar, unipolar, single-site atrioventricular pacing, and intrinsic rhythm. Each patient was his or her own control, and all pacing comparisons were implemented in random sequence. Single-ventricle palliation was performed for 17 children ages 0-21 years. Pacing increased mean arterial pressure (MAP) versus intrinsic rhythm, with the following configurations: bipolar multisite pacing increased MAP by 2.2 % (67.7 ± 2.4 to 69.2 ± 2.4 mmHg; p = 0.013) and unipolar multisite pacing increased MAP by 2.8 % (67.7 ± 2.4 to 69.6 ± 2.7 mmHg; p = 0.002). Atrioventricular single-site pacing increased MAP by 2.1 % (67.7 ± 2.4 to 69.1 ± 2.5 mmHg: p = 0.02, insignificant difference under Bonferroni correction). The echocardiographic fractional area change in nine patients increased significantly only with unipolar pacing (32 ± 3.1 to 36 ± 4.2 %; p = 0.02). No study-related adverse events occurred. Multisite pacing optimization is safe and feasible in the early postoperative period after single-ventricle palliation, with improvements in mean arterial pressure and fractional area shortening. Further study to evaluate clinical benefits is required.
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Affiliation(s)
- Vinod Havalad
- Department of Pediatrics, Advocate Children's Hospital, 1775 Dempster Street, Park Ridge, IL, USA,
| | | | - Eva W. Cheung
- Department of Pediatrics, Columbia University, New York, NY, USA
| | | | - Alice Wang
- Department of Surgery, Columbia University, New York, NY, USA
| | - Bin Cheng
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Daniel Y. Wang
- Department of Medicine, Columbia University, New York, NY, USA
| | - Eric Silver
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Emile A. Bacha
- Department of Surgery, Columbia University, New York, NY, USA
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26
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Hui W, Slorach C, Dragulescu A, Mertens L, Bijnens B, Friedberg MK. Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot. Circ Cardiovasc Imaging 2014; 7:610-8. [DOI: 10.1161/circimaging.113.001483] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wei Hui
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Cameron Slorach
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Andreea Dragulescu
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Luc Mertens
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Bart Bijnens
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
| | - Mark K. Friedberg
- From the Division of Pediatric Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (W.H., C.S., A.D., L.M., M.K.F.); and ICREA-Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (B.B.)
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27
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Motonaga KS, Dubin AM. Cardiac resynchronization therapy for pediatric patients with heart failure and congenital heart disease: a reappraisal of results. Circulation 2014; 129:1879-91. [PMID: 24799504 DOI: 10.1161/circulationaha.113.001383] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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Dubin AM, Berul CI. Electrophysiological interventions for treatment of congestive heart failure in pediatrics and congenital heart disease. Expert Rev Cardiovasc Ther 2014; 5:111-8. [PMID: 17187462 DOI: 10.1586/14779072.5.1.111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heart failure therapy, while well tested in the adult population, therapeutic interventions are less well defined in the pediatric population. Several treatment strategies are available for the adult patient with heart failure, thought few of these therapies have been proven in children. Morbidity and mortality in the pediatric population with a failing heart is significant, and rhythm management as well as strategies to improve hemodynamics are important in the care of these children. This review will address issues of rhythm management and resynchronization therapy in pediatric and congenital heart disease patients with heart failure.
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Affiliation(s)
- Anne M Dubin
- Stanford University, 750 Welch Rd., Suite 305, Palo Alto, CA 94304, USA.
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Motonaga KS, Khairy P, Dubin AM. Electrophysiologic Therapeutics in Heart Failure in Adult Congenital Heart Disease. Heart Fail Clin 2014; 10:69-89. [DOI: 10.1016/j.hfc.2013.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bautista-Hernandez V, Myers PO, Cecchin F, Marx GR, Del Nido PJ. Late left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg 2013; 148:254-8. [PMID: 24100093 DOI: 10.1016/j.jtcvs.2013.08.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/08/2013] [Accepted: 08/16/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Early results for anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) are excellent. However, the development of left ventricular dysfunction late after repair remains a concern. In this study we sought to determine factors leading to late left ventricular dysfunction and the impact of cardiac resynchronization as a primary and secondary (upgrade) mode of pacing. METHODS From 1992 to 2012, 106 patients (median age at surgery, 1.2 years; range, 2 months to 43 years) with ccTGA had anatomic repair. A retrospective review of preoperative variables, surgical procedures, and postoperative outcomes was performed. RESULTS In-hospital deaths occurred in 5.7% (n = 6), and there were 3 postdischarge deaths during a mean follow-up period of 5.2 years (range, 7 days to 18.2 years). Twelve patients (12%) developed moderate or severe left ventricular dysfunction. Thirty-eight patients (38%) were being paced at latest follow-up evaluation. Seventeen patients had resynchronization therapy, 9 as an upgrade from a prior dual-chamber system (8.5%) and 8 as a primary pacemaker (7.5%). Factors associated with left ventricular dysfunction were age at repair older than 10 years, weight greater than 20 kg, pacemaker implantation, and severe neo-aortic regurgitation. Eight of 9 patients undergoing secondary cardiac resynchronization therapy (upgrade) improved left ventricular function. None of the 8 patients undergoing primary resynchronization developed left ventricular dysfunction. CONCLUSIONS Late left ventricular dysfunction after anatomic repair of ccTGA is not uncommon, occurring most often in older patients and in those requiring pacing. Early anatomic repair and cardiac resynchronization therapy in patients requiring a pacemaker could preclude the development of left ventricular dysfunction.
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Affiliation(s)
- Victor Bautista-Hernandez
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass; Department of Pediatric Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Mass
| | - Patrick O Myers
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass
| | - Frank Cecchin
- Department of Cardiovascular Surgery, Area de Gestion Integrada A Coruña, A Coruña, Spain
| | - Gerald R Marx
- Department of Cardiovascular Surgery, Area de Gestion Integrada A Coruña, A Coruña, Spain
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass.
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Wang A, Cabreriza SE, Havalad V, Aponte-Patel L, Gonzalez G, Velez de Villa B, Cheng B, Spotnitz HM. Effects of biventricular pacing on left heart twist and strain in a porcine model of right heart failure. J Surg Res 2013; 185:645-52. [PMID: 23890399 DOI: 10.1016/j.jss.2013.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biventricular pacing (BiVP) improves cardiac output (CO) in selected cardiac surgery patients, but response remains variable, necessitating a better understanding of the mechanism. Accordingly, we used speckle tracking echocardiography (STE) to analyze BiVP during acute right ventricular pressure overload (RVPO). MATERIALS AND METHODS In nine pigs, the inferior vena cava (IVC) was snared to decrease CO and establish a control model. Heart block was induced, the pulmonary artery snared, and BiVP initiated. Echocardiograms of the left ventricular midpapillary level were taken at varying atrioventricular delay (AVD) and interventricular delay (VVD) for STE analysis of regional circumferential strain (CS) and radial strain (RS). Echocardiograms were taken of the left ventricular base, midpapillary, and apex during baseline, IVC occlusion, and each BiVP setting for STE analysis of twist, apical and basal rotations, CS, RS, and synchrony. Indices were correlated against CO with mixed linear models. RESULTS During IVC occlusion, CO correlated with twist, apical rotation, RS, RS synchrony, and CS (P < 0.05). During RVPO with BiVP, CO only correlated with RS synchrony and CS (P < 0.05). During AVD and VVD variations, CO was associated with free wall RS (P < 0.008). CO correlated with septal wall CS during AVD variation and free wall CS during VVD variation (P < 0.008). CONCLUSIONS In an open chest model, twist, RS, RS synchrony, and CS analyzed by STE may be noninvasive surrogates for changes in CO. During RVPO, changes in RS synchrony and CS with varying regional strain contributions may be the primary mechanism in which BiVP improves CO. Lack of correlation of remaining indices may reflect postsystolic function.
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Affiliation(s)
- Alice Wang
- Department of Surgery, Columbia Presbyterian Medical Center, New York, New York; Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children. Echocardiography 2013; 30:460-71. [DOI: 10.1111/echo.12110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cardiac resynchronization therapy for patients with congenital heart disease: technical challenges. J Interv Card Electrophysiol 2012; 36:71-9. [DOI: 10.1007/s10840-012-9726-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
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Jalal Z, Bordachar P, Labrousse L, Mondoly P, Ritter P, Thambo JB. Stimulation cardiaque en pédiatrie : indications, stratégies d’implantation, évolution, techniques d’avenir. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2012. [DOI: 10.1016/s1878-6480(12)70825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Biventricular pacing improves left ventricular function by 2-D strain in right ventricular failure. J Surg Res 2012; 178:571-7. [PMID: 22748597 DOI: 10.1016/j.jss.2012.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/24/2012] [Accepted: 06/01/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND We used speckle-tracking echocardiography to test the hypothesis that regional left ventricular (LV) strain would improve during optimized biventricular pacing (BiVP) in acute right ventricular (RV) pressure overload (PO). MATERIALS AND METHODS Complete heart block and RVPO were induced in five open-chest fully anesthetized pigs. BiVP was optimized by adjusting atrioventricular and interventricular delays to maximize cardiac output derived from an aortic flow probe. LV short axis views were obtained during atrio-RV pacing (RVP), atrio-LV pacing (LVP), and BiVP. Intraventricular synchrony was assessed by comparing speckle-tracking echocardiography-derived time to peak (TTP) strain in the anterior septal (AS) and posterior wall segments. Segmental function was assessed using radial strain. RESULTS Cardiac output was higher with optimized (RV first) BiVP than with LVP (0.96 ± 0.26 L/min versus 0.89 ± 0.27 L/min; P = 0.05). AS TTP strain (502 ± 19 ms) during LVP was prolonged versus BiVP (392 ± 58 ms) and versus RVP (390 ± 53 ms) (P = 0.0018). AS TTP strain during LVP was prolonged versus posterior (502 ± 19 ms versus 396 ± 72 ms, P = 0.0011). No significant difference in TTP strain in these segments was seen with BiVP or RVP. Posterior strain (20% ± 5%) increased 66% versus AS strain (12% ± 6%) during BiVP (P = 0.0029). A similar increase occurred during RVP (posterior 20% ± 3% versus AS 12% ± 7%, P = 0.0002). Posterior strain did not increase during LVP. CONCLUSIONS BiVP and RVP restore intraventricular LV synchrony and increase regional function versus LVP during RVPO. RV pre-excitation unloads the RV and reduces the duration of AS contraction, facilitating synchrony of all LV segments and increasing free wall LV contraction.
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Guihaire J, Haddad F, Mercier O, Murphy DJ, Wu JC, Fadel E. The Right Heart in Congenital Heart Disease, Mechanisms and Recent Advances. ACTA ACUST UNITED AC 2012; 8:1-11. [PMID: 23483726 DOI: 10.4172/2155-9880.s8-010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In patients with congenital heart disease, the right heart may support the pulmonary or the systemic circulation. Several congenital heart diseases primarily affect the right heart including Tetralogy of Fallot, transposition of great arteries, septal defects leading to pulmonary vascular disease, Ebstein anomaly and arrhythmogenic right ventricular cardiomyopathy. In these patients, right ventricular dysfunction leads to considerable morbidity and mortality. In this paper, our objective is to review the mechanisms and management of right heart failure associated with congenital heart disease. We will outline pearls and pitfalls in the management of congenital heart disease affecting the right heart and highlight recent advances in the field.
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Affiliation(s)
- Julien Guihaire
- Cardiac Surgeon, Universite Paris-Sud, Laboratory of Surgical Research, Marie Lannelongue Surgical Center, France
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Bronicki RA, Chang AC. Management of the postoperative pediatric cardiac surgical patient. Crit Care Med 2011; 39:1974-84. [PMID: 21768801 DOI: 10.1097/ccm.0b013e31821b82a6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the salient aspects and latest advances in the management of the postoperative pediatric cardiac patient. DATA SOURCE A Medline-based literature source. CONCLUSION The practice of pediatric cardiac intensive care has evolved considerably over the last several years. These efforts are the result of a collaborative effort from all subspecialties involved in the care of pediatric patients with congenital heart disease. Discoveries and innovations that are representative of this effort include the extension of cerebral oximetry from the operating room into the critical care setting; mechanical circulatory devices designed for pediatric patients; and surgery in very low birth weight neonates. Advances such as these impact postoperative management and make the field of pediatric cardiac intensive care an exciting, demanding, and evolving discipline, necessitating the ongoing commitment of various disciplines to pursue a greater understanding of disease processes and how to best go about treating them.
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Cohen M, Saul JP, Batra AS, Friedman R, Janoušek J. Acute Cardiac Resynchronization Therapy for the Failing Left, Right, or Single Ventricle After Repaired Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2011; 2:424-9. [DOI: 10.1177/2150135111406937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Use of cardiac resynchronization in children and young adults with congenital heart disease has been described in a variety of anecdotal cases and pooled institutional summaries which report mid-term results. This manuscript addresses use of cardiac resynchronization and/or multisite pacing in children in the acute postoperative period with a failing right, left, or single ventricle.
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Affiliation(s)
- Mitchell Cohen
- Phoenix Children’s Hospital & Arizona Pediatric Cardiology/Pediatrix, Phoenix, AZ, USA
| | - J. Philip Saul
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Richard Friedman
- Texas Children’s Hospital & Baylor Medical Center, Houston, TX, USA
| | - Jan Janoušek
- Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic
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Abstract
Temporary epicardial pacing is commonly used for the diagnosis and treatment of arrhythmias in the acute post operative period after surgery for congenital heart disease. Temporary epicardial pacemakers have become increasingly sophisticated over the years and have evolved from simple single chamber devices with few programmable parameters to complex dual chamber devices capable of adjustable parameters similar to permanent pacemakers. This review will describe the various indications for temporary pacing, technical considerations for both the choice of pacing wires and pacemaker modes, complications with temporary pacing and our current practice with temporary pacing.
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Affiliation(s)
- Anjan S Batra
- Department of Pediatric Cardiology, University of California Irvine, Orange, USA
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Batra AS, Balaji S. Cardiac resynchronization therapy in children. Curr Cardiol Rev 2011; 5:40-4. [PMID: 20066147 PMCID: PMC2803287 DOI: 10.2174/157340309787048167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 07/19/2008] [Accepted: 07/19/2008] [Indexed: 11/22/2022] Open
Abstract
Cardiac Resynchronization therapy has become an important management tool in adults with heart failure and dilated cardiomyopathy. The role of CRT in children with CHF is still unclear. Evidence is slowly emerging in the pediatric cardiology literature that CRT may have an important and useful role in certain select populations with CHF. These include patients with complete heart block who develop pacing-induced cardiomyopathy, certain forms of congenital heart disease associated with systemic ventricular failure (even if the systemic ventricle is a morphologic RV) and in patients with idiopathic dilated cardiomyopathy. Studies in children supporting the use of CRT include many case reports, a few studies of CRT in post-operative patients, and one multi-center registry reporting the use of CRT in children. These papers will be summarized.
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Affiliation(s)
- Anjan S Batra
- Departments of Pediatric Cardiology, Children's Hospital of Orange County, University of California, Irvine, California
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Electrical dyssynchrony and resynchronization in tetralogy of Fallot. Heart Rhythm 2011; 8:909-14. [DOI: 10.1016/j.hrthm.2010.12.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/25/2010] [Indexed: 11/18/2022]
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Thambo JB, Dos Santos P, Bordachar P. Cardiac resynchronization therapy in patients with congenital heart disease. Arch Cardiovasc Dis 2011; 104:410-6. [DOI: 10.1016/j.acvd.2011.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Vichova Z, Hénaine R, Basto Duarte M, Lehot JJ, Cannesson M. Impact of biventricular and left ventricular pacing on hemodynamics and left ventricular dyssynchrony compared with right ventricular pacing in the early postoperative period following cardiac surgery. ACTA ACUST UNITED AC 2011; 30:403-9. [DOI: 10.1016/j.annfar.2011.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 02/09/2011] [Indexed: 11/27/2022]
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Abstract
The management of heart failure in children is becoming a specialized discipline within pediatric cardiology. Unlike the treatment of heart failure in adults, for which an extensive body of literature supports current treatment regimens, management of heart failure in children is largely guided by extrapolation from adult studies and expert opinion. This review focuses on the current state-of-the-art with respect to the outpatient management of heart failure in children.
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Thambo JB, Roubertie F, De Guillebon M, Labrousse L, Iriart X, Ntsinjana H, Lafitte S, Ploux S, Haissaguerre M, Roques X, Dos Santos P, Bordachar P. Validation of an animal model of right ventricular dysfunction and right bundle branch block to create close physiology to postoperative tetralogy of Fallot. Int J Cardiol 2010; 154:38-42. [PMID: 20851478 DOI: 10.1016/j.ijcard.2010.08.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/19/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the past 5 years a few number of studies and case reports have come out focusing on biventricular (BiV) stimulation for treatment of congenital heart disease related ventricular dysfunction. The few available studies include a diverse group of pathophysiological entities ranging from a previously repaired tetralogy of Fallot (TOF) to a functional single ventricle anatomy. Patient's status is too heterogeneous to build important prospective study. To well understand the implication of prolonged electromechanical dyssynchrony we performed a chronic animal model that mimics essential parameters of postoperative TOF. METHODS Significant pulmonary regurgitation, mild stenosis, as well as right ventricular outflow tract (RVOT) scars were induced in 15 piglets to mimic repaired TOF. 4 months after hemodynamics and dyssynchrony parameters were compared with a control group and with a population of symptomatic adult with repaired TOF. RESULTS Comparing the animal model with the animal control group on echocardiography, RV dilatation, RV and LV dysfunction, broad QRS complex and dyssynchrony were observed on the animal model piglets. Moreover, epicardial electrical mapping showed activation consistent with a right bundle branch block. The animal models displayed the same pathophysiological parameters as the post TOF repair patients in terms of QRS duration, pulmonary regurgitation biventricular dysfunction and dyssynchrony. CONCLUSION This chronic swine model mimics electromechanical ventricular activation delay, RV and LV dysfunction, as in adult population of repair TOF. It does appear to be a very useful and interesting model to study the implication of dyssynchrony and the interest of resynchronization therapy in TOF failing ventricle.
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Tratamiento basado en la evidencia de la insuficiencia cardiaca derecha: una revisión sistemática de un campo empírico. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70066-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jeewa A, Pitfield AF, Potts JE, Soulikias W, DeSouza ES, Hollinger AJ, Sandor GGS, LeBlanc JG, Campbell AM, Sanatani S. Does biventricular pacing improve hemodynamics in children undergoing routine congenital heart surgery? Pediatr Cardiol 2010; 31:181-7. [PMID: 19936587 DOI: 10.1007/s00246-009-9581-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/23/2009] [Indexed: 11/25/2022]
Abstract
Biventricular (BiV) pacing or cardiac resynchronization therapy (CRT) is an established therapy for heart failure in adults. In children, cardiac dyssynchrony occurs most commonly following repair of congenital heart disease (CHD) where multisite pacing has been shown to improve both hemodynamics and ventricular function. Determining which patient types would specifically benefit has not yet been established. A prospective, repeated measures design was undertaken to evaluate BiV pacing in a cohort of children undergoing biventricular repair for correction of their CHD. Hemodynamics, arterial blood gas, electrocardiographic (ECG), and echocardiographic data were collected. Pacing protocol was undertaken prior to the patient's extubation with 20 min of conventional right ventricular (RV) or BiV pacing, preceded and followed by 10 min of recovery time. Multivariate statistics were used to analyze the data with p values <0.05 considered significant. Twenty-five (14 female) patients underwent surgery at a median (range) age of 5.2 (0.1-37.4) months with no early mortality. The Risk-adjusted classification for Congenital Heart Surgery (RACHS) scores were 2 in 14 patients, 3 in eight patients, and 4 in three patients. None had pre-existing arrhythmias, dyssynchrony, or required pacing pre-operatively. No patient required implantation of a permanent pacemaker post-operatively. The median cardio-pulmonary bypass time was 96 (55-236) min. RV and BiV pacing did not improve cardiac index from baseline (3.23 vs. 3.42 vs. 3.39 L/min/m2; p > 0.05). The QRS duration was not changed with pacing (100 vs. 80 vs. 80 ms; p > 0.05). On echocardiography, the time-to-peak velocity difference between the septal and posterior walls (synchrony) during pacing was similar to baseline and was also not statistically significant. BiV pacing did not improve cardiac output when compared to intrinsic sinus rhythm or RV pacing in this cohort of patients. Our study has shown that BiV pacing is not indicated in children who have undergone routine BiV congenital heart surgery. Further prospective studies are needed to assess the role of multisite pacing in children with ventricular dyssynchrony such as those with single ventricles, those undergoing reoperation or those with high RACHS scores.
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Affiliation(s)
- Aamir Jeewa
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
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Thambo JB, Dos Santos P, De Guillebon M, Roubertie F, Labrousse L, Sacher F, Iriart X, Lafitte S, Ploux S, Jais P, Roques X, Haissaguerre M, Ritter P, Clementy J, Narayan SM, Bordachar P. Biventricular stimulation improves right and left ventricular function after tetralogy of Fallot repair: acute animal and clinical studies. Heart Rhythm 2009; 7:344-50. [PMID: 20185107 DOI: 10.1016/j.hrthm.2009.11.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 11/18/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal treatment of right ventricular (RV) dysfunction observed in patients after tetralogy of Fallot (TOF) repair is unclear. Studies of biventricular (BiV) stimulation in patients with congenital heart disease have been retrospective or have included patients with heterogeneous disorders. OBJECTIVE The purpose of this study was to determine the effects on cardiac function of stimulating at various cardiac sites in an animal model of RV dysfunction and dyssynchrony and in eight symptomatic adults with repaired TOF. METHODS Pulmonary stenosis and regurgitation as well as RV scars were induced in 15 piglets to mimic repaired TOF. The hemodynamic effects of various configurations of RV and BiV stimulation were compared with sinus rhythm (SR) 4 months after surgery. In eight adults with repaired TOF, RV and left ventricular (LV) dP/dt(max) were measured invasively during SR, apical RV stimulation, and BiV stimulation. RESULTS At 4 months, RV dilation, dysfunction, and dyssynchrony were present in all piglets. RV stimulation caused a decrease in LV function but no change in RV function. In contrast, BiV stimulation significantly improved LV and RV function (P < .05). Echocardiography and epicardial electrical mapping showed activation consistent with right bundle branch block during SR and marked resynchronization during BiV stimulation. In patients with repaired TOF, BiV stimulation increased significantly RV and LV dP/dt(max) (P < .05). CONCLUSION In this swine model of RV dysfunction and in adults with repaired TOF, BiV stimulation significantly improved RV and LV function by alleviating electromechanical dyssynchrony.
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50
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Friedberg MK, Dubin AM, Van Hare GF, McDaniel G, Niksch A, Rosenthal DN. Acute Effects of Single-site Pacing from the Left and Right Ventricle on Ventricular Function and Ventricular-Ventricular Interactions in Children with Normal Hearts. CONGENIT HEART DIS 2009; 4:356-61. [DOI: 10.1111/j.1747-0803.2009.00327.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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