Abstract
The use of cardiac resynchronization therapy (CRT) is increasing for adult patients with heart failure refractory to pharmacological therapy. However, the use of CRT in pediatric patients has been limited, hence its benefits are largely unknown. A five-month-old boy presented with failure to thrive over a period of 2 months and was subsequently diagnosed with idiopathic dilated cardiomyopathy (IDCM) on echocardiogram, showing severe left ventricular dysfunction and dilatation. Pharmacological therapy, including diuretics, ACE inhibitor, and beta-blocker, was initiated, but resulted in only a moderate decrease in plasma brain natriuretic peptide (BNP) from 3,550 pg/ml to 1,050 pg/ml, without improvement in weight gain. Since the heart failure was resistant to medical therapy and ventricular dyssynchrony was evident on echocardiogram, biventricular DDD pacemaker was implanted at the age of 16 months. The CRT clearly improved his clinical symptoms, with normal weight gain and normalized plasma BNP over the following 10 months. The size and function of the left ventricle also normalized with reduced dyssynchrony.In summary, we present the impressive effects of CRT in a one-year-old boy with IDCM induced refractory heart failure. This case suggests that early identification of ventricular dyssynchrony and instigation of CRT may be a promising therapeutic strategy for pediatric patients with severe heart failure, including IDCM.
