Cardiac resynchronization therapy (CRT) is a new method of treatment for refractory
heart failure. However, for children, its indication, efficacy, and long-term prognosis remain unclear. This study describes the use of CRT for a 3-year-old girl with intractable
heart failure caused by isolated
left ventricular non-compaction (LVNC) with narrow
QRS complex.
Echocardiography showed diffuse
hypokinetic left ventricular (LV) wall motion (
ejection fraction =29.3%) with dyssynchrony between the apex,
posterior and lateral walls, where numerous prominent trabeculations existed, and severe
mitral regurgitation. Biventricular resynchronization using
epicardial pacing leads was performed under
general anesthesia. Pacing sites for optimal synchronization in the ventricular walls where chosen using
tissue Doppler imaging, and AV delay was adjusted to achieve maximal
systolic blood pressure and maximal
cardiac output. Over a follow-up period of 2 years, she exhibited significant and sustained improvement in LV function and
clinical symptoms. BNP levels decreased from 1,960 to 82 pg/ml.
QRS duration (103 ms) on
ECG did not change after CRT. We conclude that
pediatric CRT provides a highly useful
adjunct for the treatment of
heart failure, even in patients with a narrow
QRS duration, and might improve the prognosis of patients with LVNC. (Circ J 2009; 73: 2173-2177).
