PMID- 29759779
OWN - NLM
STAT- MEDLINE
DCOM- 20190712
LR  - 20190712
IS  - 2405-5018 (Electronic)
IS  - 2405-500X (Linking)
VI  - 3
IP  - 8
DP  - 2017 Aug
TI  - 16 Years of Cardiac Resynchronization Pacing Among Congenital Heart 
      Disease Patients: Direct Contractility (dP/dt-max) Screening When the 
      Guidelines Do Not Apply.
PG  - 830-841
LID - S2405-500X(17)30127-5 [pii]
LID - 10.1016/j.jacep.2017.01.015 [doi]
AB  - OBJECTIVES: The purpose of this study was to use direct cardiac resynchronization 
      therapy (CRT)-paced contractility (dP/dt-max) response as a pre-implantation 
      evaluation among patients with congenital heart disease (CHD) and follow clinical 
      parameters and contractility indexes after CRT implantation. BACKGROUND: Patients 
      with CHD often develop early heart failure with few therapeutic options, leading 
      to heart transplantation (HT). Unfortunately, guidelines for CRT do not apply, 
      and function evaluations by cardiac ultrasound are often inaccurate among CHD 
      anatomies. Therefore, which CHD patients would benefit from CRT remains an 
      enigma. METHODS: From 1999 to 2015, 103 CHD patients with New York Heart 
      Association (NYHA) functional class II to IV were listed for HT; 40 patients on 
      optimal medical therapy were referred for paced contractility response cardiac 
      catheterization before CRT consideration. If dP/dt-max improved >/=15% from 
      baseline, these "responders" were given the option of CRT with continued 
      follow-up after implantation. RESULTS: Of 40 patients studied, 26 (65%) (age 22 +/- 
      8.2 years; 9 of 26 [35%] single or systemic right ventricle; 17 of 26 [65%] with 
      pacemakers) met criteria for possible hemodynamic benefit and underwent CRT 
      implantation. All 26 patients improved in NYHA functional classification: 5 of 26 
      patients (19%) were later relisted for HT (4 to 144 months, mean 55 months) after 
      CRT implantation, whereas 21 of 26 (81%) continued with improved NYHA functional 
      class (12 to 112 months, mean 44 months) later. A repeat dP/dt-max study 
      following long-term CRT showed stable function or continued contractility 
      improvement. CONCLUSIONS: Heart failure is common among CHD patients, and 
      therapies are limited. CRT guidelines do not address clinical and anatomic issues 
      of CHD. Short-term paced contractility response testing identifies those CHD 
      patients who are likely to respond to CRT regardless of anatomy.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Karpawich, Peter P
AU  - Karpawich PP
AD  - Section of Cardiology, Department of Pediatrics, The Children's Hospital of 
      Michigan, Wayne State University School of Medicine, Detroit, Michigan. 
      Electronic address: pkarpawi@dmc.org.
FAU - Bansal, Neha
AU  - Bansal N
AD  - Section of Cardiology, Department of Pediatrics, The Children's Hospital of 
      Michigan, Wayne State University School of Medicine, Detroit, Michigan.
FAU - Samuel, Sharmeen
AU  - Samuel S
AD  - Section of Cardiology, Department of Pediatrics, The Children's Hospital of 
      Michigan, Wayne State University School of Medicine, Detroit, Michigan.
FAU - Sanil, Yamuna
AU  - Sanil Y
AD  - Section of Cardiology, Department of Pediatrics, The Children's Hospital of 
      Michigan, Wayne State University School of Medicine, Detroit, Michigan.
FAU - Zelin, Kathleen
AU  - Zelin K
AD  - Section of Cardiology, Department of Pediatrics, The Children's Hospital of 
      Michigan, Wayne State University School of Medicine, Detroit, Michigan.
LA  - eng
PT  - Journal Article
DEP - 20170426
PL  - United States
TA  - JACC Clin Electrophysiol
JT  - JACC. Clinical electrophysiology
JID - 101656995
SB  - IM
CIN - JACC Clin Electrophysiol. 2017 Aug;3(8):842-843. PMID: 29759780
MH  - Adolescent
MH  - Adult
MH  - *Cardiac Resynchronization Therapy
MH  - Cardiac Resynchronization Therapy Devices
MH  - Child
MH  - Child, Preschool
MH  - Defibrillators, Implantable
MH  - Female
MH  - Heart Defects, Congenital/diagnosis/*therapy
MH  - Heart Function Tests
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Young Adult
OTO - NOTNLM
OT  - congenital heart
OT  - dP/dt-max
OT  - heart failure
OT  - resynchronization pacing
OT  - ventricular contractility
EDAT- 2018/05/16 06:00
MHDA- 2019/07/13 06:00
CRDT- 2018/05/16 06:00
PHST- 2016/09/16 00:00 [received]
PHST- 2016/12/29 00:00 [revised]
PHST- 2017/01/12 00:00 [accepted]
PHST- 2018/05/16 06:00 [entrez]
PHST- 2018/05/16 06:00 [pubmed]
PHST- 2019/07/13 06:00 [medline]
AID - S2405-500X(17)30127-5 [pii]
AID - 10.1016/j.jacep.2017.01.015 [doi]
PST - ppublish
SO  - JACC Clin Electrophysiol. 2017 Aug;3(8):830-841. doi: 
      10.1016/j.jacep.2017.01.015. Epub 2017 Apr 26.