Resynchronization therapy in pediatric and congenital heart disease patients - An international multicenter study
Resynchronization therapy in pediatric and congenital heart disease patients - An international multicenter study
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DOI：
10.1016/j.jacc.2005.05.096
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发表时间：
2005-12-20
影响因子：
24
通讯作者：
Collins, KK
中科院分区：
文献类型：
--
作者：
Dubin, AM;Janousek, J;Collins, KK
目的 我们的目的是评估儿童心脏再同步治疗 (CRT) 的短期安全性和有效性。背景心脏再同步治疗对于左心室功能较差和心室内传导延迟的成年患者有益。该疗法对年轻人和先天性心脏病 (CHD) 患者的疗效尚未确定。 方法 这是对来自 22 个机构的 103 名患者进行的多中心、回顾性评估。 结果 植入时的中位年龄为 12.8 岁（3 个月至 55.4 岁）。中位随访时间为四个月（22 天至 1 年）。 73 名患者（71%）诊断为冠心病，16 名患者（16%）诊断为心肌病，14 名患者（13%）诊断为先天性完全性房室传导阻滞。起搏前的 QRS 时限为 166.1 +/- 33.3 ms，CRT 后减少了 37.7 +/- 30.7 ms (p < 0.01)。 CRT 前全身心室射血分数 (EF) 为 26.2 +/- 11.6%。 CRT 后 EF 增加了 12.8 +/- 12.7 EF 单位，平均 EF 为 39.9 +/- 14.8% (p < 0.05)。在 18 名在列入心脏移植名单时接受 CRT 的患者中，3 名病情改善足以从移植等待名单中删除，5 名接受了移植，2 名死亡，另外 8 名目前正在等待移植。 结论 心脏再同步化治疗似乎为儿科和先心病患者带来了益处，这些患者与迄今为止对该疗法进行最彻底评估的成人人群有很大不同。需要进一步研究该疗法对该人群的长期益处。
OBJECTIVES Our objective was to evaluate the short-term safety and efficacy of cardiac resynchronization therapy (CRT) in children.BACKGROUND Cardiac resynchronization therapy has been beneficial for adult patients with poor left ventricular function and intraventricular conduction delay. The efficacy of this therapy in the young and in those with congenital heart disease (CHD) has not yet been established.METHODS This is a multi-center, retrospective evaluation of CRT in 103 patients from 22 institutions.RESULTS Median age at time of implantation was 12.8 years (3 months to 55.4 years). Median duration of follow-up was four months (22 days to 1 year). The diagnosis was CHD in 73 patients (71%), cardiomyopathy in 16 (16%), and congenital complete atrioventricular block in 14 (13%). The QRS duration before pacing was 166.1 +/- 33.3 ms, which decreased after CRT by 37.7 +/- 30.7 ms (p < 0.01). Pre-CRT systemic ventricular ejection fraction (EF) was 26.2 +/- 11.6%. The EF increased by 12.8 +/- 12.7 EF units with a mean EF after CRT of 39.9 +/- 14.8% (p < 0.05). Of 18 patients who underwent CRT while listed for heart transplantation, 3 improved sufficiently to allow removal from the transplant waiting list, 5 underwent transplant, 2 died, and 8 others are currently awaiting transplant.CONCLUSIONS Cardiac resynchronization therapy appears to offer benefit in pediatric and CHD patients who differ substantially from the adult populations in whom this therapy has been most thoroughly evaluated to date. Further studies looking at the long-term benefit of this therapy in this population are needed.