Cardiac resynchronization therapy improves the ventricular function of patients with Fontan physiology

“…CRT for patients with single-ventricle (SV) physiology is becoming increasingly common. 2 However, the evidence regarding the use of CRT in such patients is insufficient. In CRT for patients with SV physiology, we need to take the morphology of the systemic ventricle and mechanism of dyssynchrony into account.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy Using Single Site Left Ventricular Pacing in a Tricuspid Atresia Patient With Left Bundle Branch Block

Janoušek

Ikegawa

et al. 2022

CJC Pediatric and Congenital Heart Disease

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“…In Fontan patients with heart block or intact conduction with significant dyssynchrony, cardiac resynchronization therapy with dual-site ventricular pacing has shown mixed results though recent data has demonstrated improved indices of ventricular function that are less dependent upon ventricular anatomy and geometry. These improved indices also appear to correlate with improved New York Heart Association classification ( 118 ).…”

Section: Treatmentmentioning

confidence: 91%

Management of circulatory failure after Fontan surgery

2022

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With improvement in survival after Fontan surgery resulting in an increasing number of older survivors, there are more patients with a Fontan circulation experiencing circulatory failure each year. Fontan circulatory failure may have a number of underlying etiologies. Once Fontan failure manifests, prognosis is poor, with patient freedom from death or transplant at 10 years of only about 40%. Medical treatments used include traditional heart failure medications such as renin-angiotensin-aldosterone system blockers and beta-blockers, diuretics for symptomatic management, antiarrhythmics for rhythm control, and phosphodiesterase-5 inhibitors to decrease PVR and improve preload. These oral medical therapies are typically not very effective and have little data demonstrating benefit; if there are no surgical or catheter-based interventions to improve the Fontan circulation, patients with severe symptoms often require inotropic medications or mechanical circulatory support. Mechanical circulatory support benefits patients with ventricular dysfunction but may not be as useful in patients with other forms of Fontan failure. Transplant remains the definitive treatment for circulatory failure after Fontan, but patients with a Fontan circulation face many challenges both before and after transplant. There remains significant room and urgent need for improvement in the management and outcomes of patients with circulatory failure after Fontan surgery.

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Cardiac resynchronization therapy improves the ventricular function of patients with Fontan physiology

Cited by 17 publications

References 47 publications

Fontan candidacy, optimizing Fontan circulation, and beyond

Fontan candidacy, optimizing Fontan circulation, and beyond

Cardiac Resynchronization Therapy Using Single Site Left Ventricular Pacing in a Tricuspid Atresia Patient With Left Bundle Branch Block

Management of circulatory failure after Fontan surgery

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