Abstract
PO-03-123 MULTICENTER STUDY OF THE PREDICTORS OF RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY IN PEDIATRIC AND CONGENITAL HEART DISEASE
Heart rhythm, Vol.20(5 Supplement), pp.S427-S428
05/2023
DOI: 10.1016/j.hrthm.2023.03.949
Abstract
Background
Cardiac resynchronization therapy (CRT) is an important therapeutic option in selected pediatric and congenital heart disease (CHD) patients with reduced systemic ventricular (SV) ejection fraction (EF). However, the identification of optimal responders is challenging. This is highly pertinent in the context of the increased technicalities of CRT implant procedures compared to adults with structurally normal hearts.
Objective
To identify predictors of response to CRT in children and CHD patients in a retrospective controlled cohort at 5 large quaternary referral centers.
Methods
Patients were <21 years or had CHD; had SVEF <45%; symptomatic heart failure; and significant electrical dyssynchrony (defined as QRS duration z-score>3 or single site Vp>40%) at baseline prior to CRT. Primary outcome was defined as an ordinal response at 6/12months: (1) Improved EF [absolute increase in systemic ventricular EF ≥5%], (2) Unchanged SVEF, (3) Worse SVEF. Secondary outcome utilized a propensity score-matched non-CRT control cohort with same inclusion criteria and enrollment at outpatient encounter. Response to CRT was defined as significant positive impact of CRT upon longitudinal trajectory of long-term SVEF (data collected at 6 months, 1 yr, 5 yrs and latest follow-up).
Results
In total, 167 eligible CRT recipients (and 324 controls) were identified across the 5 centers (Table 1), and 150 had comprehensive data at 6/12months. There were 96 (64%) with improved SVEF, 26 (17%) unchanged, 28 (19%) worsened. Mean increase in SVEF was 11% [IQR 3-21%], mean decrease in QRS duration 18 (+/- 24) ms, and 15 (9%) died or were transplanted within 1yr. On univariable ordinal regression, lower SVEF (coefficient -0.05, p=0.013), biventricular circulation (coef 1.07, p=0.022), systemic LV (coef 0.96, p=0.021), and conduction delay to the lateral wall of the SV (eg LBBB in conventional ventricular arrangement, coef 0.94, p=0.01) were associated with increased likelihood of positive response.
On assessment of secondary outcome, 324 controls were identified. Mean follow-up 4.2 (±3.7) yrs. Most subgroups demonstrated an improved SVEF trend with CRT (Figure 1), except those patients with systemic RV (p=0.69) or without prior single site pacemaker (p=0.20).
Conclusion
CRT in children and CHD patients frequently results in an improvement in SVEF. Those with lower SVEF, electrical conduction delay to the lateral wall of the SV and those with systemic LV are most likely to experience positive medium and long-term responses.
Details
- Title: Subtitle
- PO-03-123 MULTICENTER STUDY OF THE PREDICTORS OF RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY IN PEDIATRIC AND CONGENITAL HEART DISEASE
- Creators
- Henry ChubbDouglas Y. MahMaully J. ShahKimberly Y. LinDavid PengDavid J. BradleyBenjamin HaleLindsay MaySusan P. EtheridgeWilliam R. GoodyerScott R. CeresnakKara S. MotonagaDavid N. RosenthalChristopher AlmondDoff McElhinneyAnne M. Dubin
- Resource Type
- Abstract
- Publication Details
- Heart rhythm, Vol.20(5 Supplement), pp.S427-S428
- DOI
- 10.1016/j.hrthm.2023.03.949
- ISSN
- 1547-5271
- eISSN
- 1556-3871
- Language
- English
- Date published
- 05/2023
- Academic Unit
- Stead Family Department of Pediatrics; Cardiology
- Record Identifier
- 9984701836102771
Metrics
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