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Although left ventricular (LV) systolic dysfunction is known to occur in adults with repaired Tetralogy of Fallot (TOF), the benefit of cardiac resynchronization therapy (CRT) in this cohort is not well described.
We retrospectively identified all patients with repaired TOF and impaired LV ejection fraction (LVEF ≤ 40%) undergoing CRT at our institution (n=10) and divided them into two groups: de novo CRT (Group A, n=6) or upgrade from existing device (Group B, n=4). Echocardiograms were reviewed at baseline (pre-CRT) and medium-term follow-up (6-12 months).CRT response was defined as a reduction in LVESV ≥ 15% at medium-term follow-up.
For all patients, age at surgical repair was 13.1 ± 16.0 yrs and age at CRT was 44.4 ± 12.5 yrs. Baseline LVEF was 24.0 ± 10.5%, New York Heart Association (NYHA) class 2.9 ± 0.6 and QRS duration 179.1 ± 36.3 msec. Group A demonstrated right ventricular (RV) conduction delay preponderance whereas all patients in Group B was RV paced at baseline. Time to medium-term follow-up was 10.4 ± 5.3 months. Group A showed significant improvements in LVEF, LVEDV and LVESV (Table). Group B also demonstrated a significant improvement in LVEF with favorable trends in LV volumes. Out of 9 patients with complete data at medium-term follow-up, 8 showed evidence of CRT response (Group A: 4/5; Group B: 4/4).
Adults with repaired TOF and LV systolic dysfunction demonstrate significant medium-term response to CRT, even among those with RV conduction delay.
|TABLE||Left ventricle ejection fraction (%)|
|Group A||21.7 ± 11.3||32.0 ± 4.5||<0.01|
|Group B||27.5 ± 9.6||42.5 ± 18.5||0.05|
|Left ventricle end-diastolic volume (cc)|
|Group A||251.5 ± 87.4||216.1 ± 86.5||0.03|
|Group B||272.0 ± 111.3||180.8 ± 42.1||0.16|
|Left ventricle end-systolic volume (cc)|
|Group A||193.7 ± 71.3||147.4 ± 55.5||0.03|
|Group B||228.1 ± 104.1||106.6 ± 5.7||0.09|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Adult Congenital Heart Disease
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1292-132
- 2013 American College of Cardiology Foundation