Cardiac resynchronization therapy in adults with congenital heart disease

Cardiac resynchronization has become a staple in the armamentarium of heart failure management in adults. However, given the heterogeneous nature of congenital heart disease it is difficult to uniformly extrapolate all adults with congenital heart disease whose ejection fraction is ≤ 35% as appropriate CRT candidates. Rather the practitioner managing a heart failure adult with congenital heart disease should think of the defect as being in one of four distinct categories: (1) failing systemic left ventricle, (2) failing systemic right ventricle, (3) failing pulmonary right ventricle, or (4) a failing single ventricle. The Pediatric and Congenital Electrophysiology Society in conjunction with the Heart Rhythm Society recently published consensus guidelines for Arrhythmia Management in the Adult with Congenital Heart Disease. Within that document, a subsection exists to provide some guidelines on CRT in this challenging population. This review will highlight the largely retrospective studies that have evaluated adults with CHD who received CRT and understand why some patients respond and others do not.