Congenital heart diseaseMeta-analysis
Effectiveness of cardiac resynchronization therapy in adult congenital heart disease: A meta-analysis of biventricular and conduction system pacing outcomes
- systematic review and meta-analysis
- following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
Authors' conclusion
CRT in ACHD is associated with significant improvements in electrocardiographic, functional, and clinical outcomes, including patients with a systemic right ventricle. Although most evidence pertains to BiV, early reports on CSP are encouraging. Prospective, phenotype-specific studies with standardized outcomes are needed to optimize patient selection and pacing strategies.
Study context
- Population
- Patients with adult congenital heart disease (ACHD) receiving cardiac resynchronization therapy (CRT)BiV 723 · conduction system pacing (CSP) 73
- Participants
- 796 patients · 25 studies
- Comparison
- effects of CRT in ACHD, including both biventricular pacing (BiV) and conduction system pacing (CSP) strategies
- BiVn = 723
- CSPn = 73
- Outcome
- Changes in QRS duration, systemic ventricular function (SVF), and New York Heart Association (NYHA) class
Pooled result
As reported in the abstract
QRS duration reduction
−23.1 ms; 95% confidence interval −31.6 to −14.7
Systemic ventricular function (SVF) improvement
+7.8%; 5.9-9.6
New York Heart Association (NYHA) class reduction
−0.9; −1.2 to −0.5
Further pooled results
Patients with a systemic right ventricle (subgroup)
- QRS
- −27.7 ms
- SVF
- +8.5%
- NYHA
- −1.0
Heart failure (HF) hospitalization and mortality (secondary)
per 100 patient-years
- Pooled incidence rate of HF hospitalization
- 4.3
- Pooled incidence rate of mortality
- 3.2
QRS narrowing, CSP vs BiV
- Early data suggest that CSP achieves comparable QRS narrowing with BiV, although long-term outcomes remain scarce
Original publication
Summarised from the published abstract; every number is checked against it