TY - JOUR
T1 - Cardiac resynchronisation therapy among adults with a systemic right ventricle
T2 - a multicentre experience
AU - Fusco, Flavia
AU - Scognamiglio, Giancarlo
AU - Dellborg, Mikael
AU - Dehghani, Payam
AU - Jameson, Susan M.
AU - Kay, W. Aaron
AU - Cramer, Jonathan W.
AU - Vonder Muhll, Isabelle
AU - Krieger, Eric V.
AU - Rodriguez, Fred H.
AU - Burchill, Luke J.
AU - Nicolarsen, Jeremy
AU - Kay, Joseph
AU - Kauling, Robert M.
AU - Shah, Sangeeta
AU - Magalski, Anthony
AU - Wong, Joshua
AU - Celermajer, David S.
AU - Baker, David William
AU - Roos-Hesselink, Jolien W.
AU - Ginde, Salil
AU - Aboulhosn, Jamil
AU - Kuo, Marissa
AU - DeZorzi, Christopher
AU - Khairy, Paul
AU - Rodriguez-Monserrate, Carla P.
AU - Kutty, Shelby
AU - Wilson, William
AU - Lubert, Adam M.
AU - Grewal, Jasmine
AU - Han, Frank
AU - Cotts, Timothy
AU - Pylypchuk, Stephen
AU - Gupta, Tripti
AU - Antonová, Petra
AU - O’Donnell, Clare
AU - John, Anitha
AU - Gallego, Pastora
AU - van Dissel, Alexandra
AU - Opotowsky, Alexander R.
AU - Yeung, Elizabeth
AU - Broberg, Craig S.
AU - Sarubbi, Berardo
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025
Y1 - 2025
N2 - Background Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV. Methods This is an international, retrospective study including patients >18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/ implantable cardioverter-defibrillator therapies. Results We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6–8) years. QRS improvement was limited to those with previous pacing (167±35 vs 154±28ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peak VO2 and tricuspid regurgitation severity by echocardiography. CRT complications occurred in 10 (9.5%), though they were usually minor. Patients with CRT were propensitymatched to controls according to age, sex, anatomy, presence of complex disease, previous HF and sRV dysfunction at baseline. At univariable analysis, CRT (HR 4.39–95%,CI 1.6 to 11.9; p=0.003), older age and moderate-to-severe sRV dysfunction at baseline were predictive of death, while CRT (HR 3–95%,CI 1.3 to 7; p=0.01) and sRV dysfunction were associated with HF admission. By multivariable analysis, CRT (HR 8.8–95%,CI 2.9 to 26.6; p=0.0001) and age (HR 1.1%– 95%,CI 1.01 to 1.15; p<0.0001) were independently associated with poorer outcome. Conclusion In this retrospective study in the largest population thus far described with an sRV, CRT implant was not associated with improved survival, even after controlling for key confounders.
AB - Background Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV. Methods This is an international, retrospective study including patients >18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/ implantable cardioverter-defibrillator therapies. Results We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6–8) years. QRS improvement was limited to those with previous pacing (167±35 vs 154±28ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peak VO2 and tricuspid regurgitation severity by echocardiography. CRT complications occurred in 10 (9.5%), though they were usually minor. Patients with CRT were propensitymatched to controls according to age, sex, anatomy, presence of complex disease, previous HF and sRV dysfunction at baseline. At univariable analysis, CRT (HR 4.39–95%,CI 1.6 to 11.9; p=0.003), older age and moderate-to-severe sRV dysfunction at baseline were predictive of death, while CRT (HR 3–95%,CI 1.3 to 7; p=0.01) and sRV dysfunction were associated with HF admission. By multivariable analysis, CRT (HR 8.8–95%,CI 2.9 to 26.6; p=0.0001) and age (HR 1.1%– 95%,CI 1.01 to 1.15; p<0.0001) were independently associated with poorer outcome. Conclusion In this retrospective study in the largest population thus far described with an sRV, CRT implant was not associated with improved survival, even after controlling for key confounders.
KW - ACHD
KW - CRT
KW - resynchronization therapy
KW - systemic right ventricle
UR - https://www.scopus.com/pages/publications/105020908592
U2 - 10.1136/heartjnl-2025-326384
DO - 10.1136/heartjnl-2025-326384
M3 - Article
C2 - 41198182
JO - Heart
JF - Heart
ER -
SDG 3 Good Health and Well-being