Pediatric/Adult Congenital Heart Disease -> Adult Congenital Heart Disease D-AB15 - Pacing in Patients with Congenital Heart Disease (ID 44) Abstract

D-AB15-04 - Right Ventricular Resynchronization With Lateral Tricuspid Annular Pacing (rv Re-sync) In Adults With Congenital Heart Disease (ID 732)


Background: RV conduction delay and dysfunction are common in adults with certain types of congenital heart disease. The feasibility and effects of endocardial resynchronization of the RV in this patient population is unknown.
Objective: To determine feasibility and preliminary outcomes of cardiac resynchronization of the RV in patients with right bundle branch block and RV dysfunction.
Methods: We performed a pilot series of 5 RV RE-SYNC implants by placing active fixation leads in the lateral tricuspid annular RV and standard ICD lead or pacing leads in the RV septum or apical septum. The lateral RV lead was used as the “LV” lead for device programming and attached to a traditional CRT device. Paired datasets of pre- and post-implant QRS duration and RV function was analyzed.
Results: Congenital lesions included Tetralogy of Fallot( TOF) (n=2), Ebstein’s anomaly (n=1), hypoplastic left heart (n=1) and other(n=1; age range 33-85; 60% female) Baseline QRS duration of the RBBB was 183ms ± 8ms, and baseline RV EF 12% ±22%. All implants were acutely successful and there were no device-related complications. In this cohort, there was a significant post-implant reduction of QRS duration (183ms ± 8ms vs 144ms ± 28ms, p<0.05) and trend toward improvement of RV ejection fraction (12% ±22% vs 38% ±8%, p= .083; mean follow-up 2.6 years). Lead position (Fig A,B) and EKG pre and post ( Fig C,D) in a patient with TOF are shown in the attached image.
Conclusion: RV endocardial resynchronization with pacing at the lateral right ventricle can improve QRS duration and RV systolic function. Our preliminary data support a larger crossover trial of this new use for CRT in the adult congenital population.