Cardiac resynchronization therapy in a child with tetralogy of Fallot

Cardiac resynchronization therapy is a common option in adult patients with heart failure and conduction abnormalities. Specific selection criteria for pediatric population are lacking. We report the case of a 14-year-old boy with signifi cant pulmonary regurgitation subsequent to corrected tetralogy of Fallot and single chamber permanent pacing which presented with heart failure symptoms. Careful management was planned by a Heart Team including pediatric cardiologist, cardiac surgeon, interventional cardiologist and anesthesiologist. After undergoing cardiac surgery with complete correction of the pulmonary regurgitation and upgrade to a triple chamber pacing, the patient was discharged in good clinical status.

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His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab277 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Dmytro Volkov ◽

Dmytro Lopin ◽

Stanislav Rybchynskyi ◽

Dmytro Skoryi

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Right Bundle Branch Block ◽

Clinical Status ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Resynchronization Therapy ◽

Bundle Branch Block ◽

Ventricular Ejection Fraction

Abstract Background Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

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Implantable cardiac resynchronization therapy devices to monitor heart failure clinical status

Current Heart Failure Reports ◽

10.1007/s11897-007-0026-1 ◽

2007 ◽

Vol 4 (1) ◽

pp. 48-52 ◽

Cited By ~ 3

Author(s):

Jeffrey Wing-Hong Fung ◽

Cheuk-Man Yu

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Clinical Status ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardiac Resynchronization Therapy Devices

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Abstract 1647: Can Left Ventricular Dyssynchrony as evaluated by Phase Analysis on Gated Myocardial Perfusion SPECT predict Response to Cardiac Resynchronization Therapy?

Circulation ◽

10.1161/circ.116.suppl_16.ii_345-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Maureen M Henneman ◽

Ji Chen ◽

Petra Dibbets-Schneider ◽

Marcel P Stokkel ◽

Gabe B Bleeker ◽

...

Keyword(s):

Heart Failure ◽

Myocardial Perfusion ◽

Cardiac Resynchronization Therapy ◽

Phase Analysis ◽

Clinical Status ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cutoff Value ◽

Lv Dyssynchrony

Purpose: Cardiac resynchronization therapy (CRT) is now a well established therapeutic option for patients with end-stage heart failure. However, not all patients respond to CRT, and therefore preimplantation identification of responders is desirable. The purpose of the present study was to investigate whether the degree of left ventricular (LV) dyssynchrony as assessed with phase analysis from gated myocardial perfusion single photon emission computed tomography (GMPS), can predict which patients will respond to CRT. Methods: Forty-two patients with severe heart failure, depressed LV ejection fraction and wide QRS complex, were prospectively included for implantation of a CRT device and underwent GMPS and 2D echocardiography as part of clinical protocol. Clinical status was evaluated using New York Heart Association (NYHA) classification, 6-minute walk test and quality-of-life score. The histogram bandwidth and phase standard deviation (SD) (parameters indicating LV dyssynchrony) were assessed from GMPS, and clinical status and echocardiographic variables were re-assessed at 6 months follow-up. Results: Responders (71%) and non-responders (29%) had comparable baseline characteristics, except for histogram bandwidth (175±63° vs 117±51°, P <0.01) and phase SD (56.3±19.9° vs 37.1±14.4°, P <0.01) which were significantly larger in responders as compared to non-responders. Moreover, receiver-operator characteristic curve analysis demonstrated an optimal cutoff value of 135° for histogram bandwidth (sensitivity and specificity of 70%) and of 43° for phase SD (sensitivity and specificity of 74%) for the prediction of response to CRT. Conclusion: Response to CRT is related to the presence of LV dyssynchrony assessed by phase analysis with GMPS. A cutoff value of 135° for histogram bandwidth and of 43° for phase SD could be used to predict response to CRT. Larger prospective studies are warranted to confirm the present findings.

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