Cardiac resynchronisation therapy among adults with a systemic right ventricle: a multicentre experience

Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF) associated with acquired heart disease, but its benefit in adults with congenital heart defects and systemic right ventricular dysfunction (SRD) remains unclear.

The primary endpoint was overall survival and HF-free survival. Secondary endpoints included a composite of death, hospitalization for HF, heart transplantation, mechanical support, and ventricular tachycardia/implantable cardioverter-defibrillator therapy.

Results. The authors identified 105 of 1,721 patients (3.5%) who underwent CRT. The median follow-up period after CRT implantation was 4.6 (1.6–8) years. Improvement in the QRS complex was observed only in patients with prior pacing (167±35 vs. 154±28 ms; p=0.002). After CRT, there were no significant changes in B-type natriuretic peptide, peak VO2, or tricuspid regurgitation severity according to echocardiography. Complications of CRT occurred in 10 (9.5%) patients, although they were usually minor. Patients with CRT were matched to the control group for prognostic factors such as age, gender, anatomical features, the presence of complex disease, prior heart failure, and right ventricular dysfunction at baseline. In univariate analysis, implantation of cardiac resynchronization therapy (CRT) (HR 4.39%–95%, CI 1.6%–11.9; p=0.003), older age, and moderate or severe right ventricular dysfunction at baseline were predictors of death, while CRT (HR 3%–95%, CI 1.3%–7%; p=0.01) and right ventricular dysfunction were associated with hospitalization for heart failure. In multivariate analysis, CRT (HR 8.8%–95%, CI 2.9%–26.6; p=0.0001) and age (HR 1.1%–95%, CI 1.01%–1.15; p<0.0001) were independently associated with worse outcome.

Conclusion. In a retrospective study of the largest population with right ventricular dysfunction described to date, CRT implantation was not associated with improved survival, even after accounting for key factors influencing outcome.

 

https://doi.org/10.1136/heartjnl-2025-326384

 

 

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