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J u l y 2 3 - 2 4 , 2 0 1 8 | R o m e , I t a l y
Cardiology Congress 2018 & Microbe Infection 2018
Note:
Page 15
allied
academies
2
nd
World Congress on
CARDIOLOGY
MICROBIOLOGY AND MICROBIAL INFECTION
&
39
th
Annual Congress on
Joint Event on
Biomedical Research
|
ISSN: 0976-1683
|
Volume 29
Peter P Karpawich, Biomed Res 2018, Volume 29 | DOI: 10.4066/biomedicalresearch-C1-001
RESYNCHRONIZATION PACING FOR
EARLY HEART FAILURE AMONG
YOUNG ADULTS WITH REPAIRED
CONGENITAL HEART DISEASE BASED ON
CONTRACTILITY (DP/DT) NOT EF OR QRS
Introduction:
Repaired congenital heart disease (CHD) patients (pts) often
develop early heart failure (HF) simply based on anatomy. Although cardiac
resynchronization pacing therapy (CRT) may be an effective alternative to heart
transplant (HT), published implant guidelines, based on ejection fraction (EF)
and QRS morphology, do not include pts with CHD or pacemakers. The purpose
of this study was to pre-evaluate CHD pts with HF based on contractility
response (dP/dt) to temporary CRT pacing to determine CRT efficacy prior
to implant. Acute CRT benefit was defined as a >15% increase in indices over
baseline.
Methods:
From 1998-2017, 105 CHD pts including repaired Tetralogy of
Fallot, transposition of the great arteries, single ventricle, and septal defects,
were considered for HT (NYHA 3-4). Of these, 40 (mean age 22y, 27/40 with
preexisting pacemakers) agreed to temporary CRT pacing with contractility
measurements. Based on dP/dt response, pts either did or did not receive CRT.
All pts was followed from 0.3-12 years (mean 4.5).
Results:
Of 40 pts, 26 (62%) had a positive response (mean dP/dt 597 improved
to 848 mmHg-sec, p<0.006) and received CRT implant. During follow-up
(mean 5.3 years), all initially improved in NYHA class and HF symptoms. Of
these pts, four underwent eventual HT (mean 4.7 years later), four died (two
noncompliance (NC), one gunshot) and 18 remain clinically stable (NHYA class
1-3), off the HT list (repeat dP/dt mean 843 mmHg-sec). Of the 14 pts with
a negative acute CRT response (mean dP/dt 635 vs. 662 mmHg-sec, p=NS),
during follow up (mean 3.5 years), two underwent HT (mean one year later), six
died awaiting HT (3 NC), and six remain on the HT list (NYHA 3-4).
Conclusions:
CRT implant guidelines lack criteria for CHD pts including
preexisting pacemakers. Pre-selecting pts by acute contractility response
assures greater CRT efficacy and can delay need for HT.
Biography
Peter P Karpawich has underwent medical training
at Hahnemann/Drexel University (Philadelphia),
followed by Pediatric Residency at the University of
Texas (Dallas) and Cardiology fellowship at Baylor
University (Houston). He holds the academic rank
of Professor at Wayne State University School of
Medicine and is the Director of Cardiac Electro-
physiology Services at the Children’s Hospital of
Michigan, Detroit, USA. He has authored/coau-
thored over 250 scientific publications, as well as
two textbooks and 11 textbook chapters on cardiac
electrophysiology, adult congenital heart diseases
and cardiac device therapies. He currently serves
as Editor and is on the Editorial Boards of several
internationally-recognized cardiac journals and is
routinely asked to review scientific manuscripts for
publication. He is a fellow of the American College
of Cardiology, American Heart Association, Heart
Rhythm Society and the American Academy of Pe-
diatrics.
pkarpawi@dmc.orgPeter P Karpawich
1,2
1
The Children’s Hospital of Michigan, USA
2
Wayne State University School of Medicine, USA