Implantation techniques and outcomes after cardiac resynchronization therapy for congenitally corrected transposition of the great arteries

Background: Patients with congenitally corrected transposition of the great arteries (CCTGA) are at risk of congestive heart failure (CHF). There are limited data on cardiac resynchronization therapy (CRT) techniques and long-term outcomes in this population.

Objective: The purpose of this study was to determine implantation techniques and efficacy of CRT for CCTGA.

Methods: A 15-year retrospective review of patients with CCTGA undergoing CRT was performed.

Results: Twenty patients were identified (mean age 40.1 ± 15.3 years; baseline New York Heart Association class 2.0 [interquartile range 1.5-3.5]). Indication was pacing-induced ventricular dysfunction in 12 (60%), atrioventricular block with anticipation for >40% ventricular pacing in 5 (25%), and intact atrioventricular conduction with CHF and QRS prolongation in 3 (15%). A transvenous approach was successful in 18 of 19 patients (95%) in whom it was attempted, with cannulation of a posteroseptal ostium in 14 (78%), vein of Marshall in 2 (11%), and superior ectopic ostium in 2 (11%). Of patients with baseline CHF, 8 (67%) were acute responders, with loss of response in 2 patients (median 1.1 and 1.5 years, respectively). Of 4 patients referred for heart transplantation, 3 (75%) could be de-listed following CRT. Only lead location in the right ventricular outflow tract predicted poor CRT response (P = .026). Post-procedure, the QRS duration increased by 4.3 ms/y (P < .001) despite stable pacing characteristics. CRT revision was required in 4 patients for infection (n = 2) or phrenic nerve capture (n = 2) and was associated with loss of CRT response in 1 patient.

Conclusion: A transvenous approach to CRT involving distinct coronary venous patterns is feasible for most patients with CCTGA anatomy. Long-term outcome is favorable, but is characterized by return of right ventricular dysfunction in some patients.