Multicenter Study of Survival Benefit of Cardiac Resynchronization Therapy in Pediatric and Congenital Heart Disease

Henry Chubb; Douglas Y Mah; Maully Shah; Kimberly Y Lin; David M Peng; Benjamin W Hale; Lindsay May; Susan Etheridge; William Goodyer; Scott R Ceresnak; Kara S Motonaga; David N Rosenthal; Christopher S Almond; Doff B McElhinney; Anne M Dubin

doi:10.1016/j.jacep.2023.11.008

Multicenter Study of Survival Benefit of Cardiac Resynchronization Therapy in Pediatric and Congenital Heart Disease

JACC Clin Electrophysiol. 2024 Mar;10(3):539-550. doi: 10.1016/j.jacep.2023.11.008. Epub 2024 Jan 10.

Authors

Affiliations

¹ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA. Electronic address: mhchubb@stanford.edu.
² Department of Cardiology, Boston Children's Hospital, Boston Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston Massachusetts, USA.
³ Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Cardiology, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
⁶ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA.
⁷ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California, USA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.

PMID: 38206260
DOI: 10.1016/j.jacep.2023.11.008

Abstract

Background: Evidence for the efficacy of cardiac resynchronization therapy (CRT) in pediatric and congenital heart disease (CHD) has been limited to surrogate outcomes.

Objectives: This study aimed to assess the impact of CRT upon the risk of transplantation or death in a retrospective, high-risk, controlled cohort at 5 quaternary referral centers.

Methods: Both CRT patients and control patients were <21 years of age or had CHD; had systemic ventricular ejection fraction <45%; symptomatic heart failure; and significant electrical dyssynchrony (QRS duration z score >3 or single-site ventricular pacing >40%) at enrollment. Patients with CRT were matched with control patients via 1:1 propensity score matching. CRT patients were enrolled at CRT implantation; control patients were enrolled at the outpatient clinical encounter where inclusion criteria were first met. The primary endpoint was transplantation or death.

Results: In total, 324 control patients and 167 CRT recipients were identified. Mean follow-up was 4.2 ± 3.7 years. Upon propensity score matching, 139 closely matched pairs were identified (20 baseline indices). Of the 139 matched pairs, 52 (37.0%) control patients and 31 (22.0%) CRT recipients reached the primary endpoint. On both unadjusted and multivariable Cox regression analysis, the risk reduction associated with CRT for the primary endpoint was significant (HR: 0.40; 95% CI: 0.25-0.64; P < 0.001; and HR: 0.44; 95% CI: 0.28-0.71; P = 0.001, respectively). On longitudinal assessment, the CRT group had significantly improved systemic ventricular ejection fraction (P < 0.001) and shorter QRS duration (P = 0.015), sustained to 5 years.

Conclusions: In pediatric and CHD patients with symptomatic systolic heart failure and electrical dyssynchrony, CRT was associated with improved heart transplantation-free survival.

Keywords: cardiac resynchronization therapy; cardiomyopathy; congenital heart disease; heart failure; heart transplant; pediatric.

Publication types

Multicenter Study

MeSH terms

Cardiac Resynchronization Therapy*
Child
Heart Defects, Congenital* / therapy
Heart Failure, Systolic* / therapy
Heart Transplantation*
Humans
Retrospective Studies