Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: Results of a randomized clinical trial. Friedberg M.K., Schwartz S.M., Zhang H., Chiu-Man C., Manlhiot C., Ilina M.V., Arsdell G.V., Kirsh J.A., McCrindle B.W., & Stephenson E.A. 2017.
Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: Results of a randomized clinical trial [link]Paper  abstract   bibtex   
Background It is unknown whether continuous cardiac resynchronization therapy (CRT) can lead to sustained improvement in hemodynamics after surgery for congenital heart disease (CHD). Objective We investigated whether CRT improves cardiac index (CI) and blood pressure in infants after biventricular repair of CHD. Methods We randomized infants younger than 4 months after biventricular CHD surgery to standard care or standard care plus CRT for 48 hours or until extubation if sooner. Change in the primary outcome of CI and blood pressure over time was compared between groups. For subgroup analysis, QRS duration was considered prolonged if greater than the 98th percentile. Results Forty-two patients were randomized: 21 controls and 21 patients receiving CRT (median weight 4 kg). There were no identified adverse events from pacing. The change in CI over time was not different between patients receiving CRT and controls, but trended toward improvement in patients with wide QRS who received CRT (n = 9) vs controls with wide QRS (n = 8) (+1.65 (0.86) L/(min.m2); P = .06). Controls with wide QRS experienced the smallest increase in CI (0.33 L/(min.m2)). Blood pressure was significantly higher in infants with wide QRS who received CRT than in controls (+7.14 (3.08) mm Hg; P = .02). Serum lactate level, catecholamine use, ventilation time, and length of intensive care unit stay were similar between the 2 groups. Conclusion CRT improved blood pressure and a trend toward higher CI in infants after repair of biventricular CHD with prolonged QRS duration. These findings warrant further study of CRT to improve postoperative recovery in infants with electrical dyssynchrony. Copyright © 2016 Heart Rhythm Society
@misc{friedberg_m.k._hemodynamic_2017,
	title = {Hemodynamic effects of sustained postoperative cardiac resynchronization therapy in infants after repair of congenital heart disease: {Results} of a randomized clinical trial},
	url = {http://www.elsevier.com/inca/publications/store/7/0/2/3/3/3/index.htt},
	abstract = {Background It is unknown whether continuous cardiac resynchronization therapy (CRT) can lead to sustained improvement in hemodynamics after surgery for congenital heart disease (CHD). Objective We investigated whether CRT improves cardiac index (CI) and blood pressure in infants after biventricular repair of CHD. Methods We randomized infants younger than 4 months after biventricular CHD surgery to standard care or standard care plus CRT for 48 hours or until extubation if sooner. Change in the primary outcome of CI and blood pressure over time was compared between groups. For subgroup analysis, QRS duration was considered prolonged if greater than the 98th percentile. Results Forty-two patients were randomized: 21 controls and 21 patients receiving CRT (median weight 4 kg). There were no identified adverse events from pacing. The change in CI over time was not different between patients receiving CRT and controls, but trended toward improvement in patients with wide QRS who received CRT (n = 9) vs controls with wide QRS (n = 8) (+1.65 (0.86) L/(min.m2); P = .06). Controls with wide QRS experienced the smallest increase in CI (0.33 L/(min.m2)). Blood pressure was significantly higher in infants with wide QRS who received CRT than in controls (+7.14 (3.08) mm Hg; P = .02). Serum lactate level, catecholamine use, ventilation time, and length of intensive care unit stay were similar between the 2 groups. Conclusion CRT improved blood pressure and a trend toward higher CI in infants after repair of biventricular CHD with prolonged QRS duration. These findings warrant further study of CRT to improve postoperative recovery in infants with electrical dyssynchrony. Copyright © 2016 Heart Rhythm Society},
	journal = {Heart Rhythm},
	author = {{Friedberg M.K.} and {Schwartz S.M.} and {Zhang H.} and {Chiu-Man C.} and {Manlhiot C.} and {Ilina M.V.} and {Arsdell G.V.} and {Kirsh J.A.} and {McCrindle B.W.} and {Stephenson E.A.}},
	year = {2017},
	keywords = {*blood pressure monitoring, *cardiac resynchronization therapy, *congenital heart disease, *congenital heart disease/su [Surgery], *congenital heart disease/th [Therapy], *heart hemodynamics, *heart surgery, *intensive care unit, *postoperative care, QRS interval, adverse drug reaction, aortopulmonary septal defect/su [Surgery], article, artificial ventilation, atresia/su [Surgery], atrioventricular septal defect/su [Surgery], catecholamine, clinical article, clinical trial, controlled clinical trial, controlled study, extracorporeal oxygenation, extubation, female, health care quality, heart index, heart left bundle branch block, heart pacing, heart right bundle branch block, heart ventricle septum defect/su [Surgery], human, human tissue, infant, lactate blood level, lactic acid/ec [Endogenous Compound], length of stay, lung vein drainage anomaly/su [Surgery], male, mean arterial pressure, mitral valve stenosis/su [Surgery], outcome assessment, pediatric intensive care unit, priority journal, pulmonary valve atresia/su [Surgery], pulmonary valve stenosis/su [Surgery], pulse pressure, randomized controlled trial, remission, side effect, surgery, systolic blood pressure}
}
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