{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:33:43Z","timestamp":1772645623519,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Cardiac resynchronization therapy (CRT) can be an effective form of heart failure (HF) management among congenital heart disease (CHD) patients (pts) with and without surgically repaired defects. However, very long-term results are limited. Recently, CRT has been implicated to be proarrhythmic among older CRT recipients. This issue is largely unknown among younger CHD-CRT pts. This study presents up to a 20-year (y) continuous review of any arrhythmia (Arr) burden associated with CRT among CHD-HF pts. Methods: From 1999 to 2024, outcomes of 45 CHD-HF pts (NYHA II-IV) (age 4\u201357 y [mean 26]; 31% female) were compared between those on established medical management (MM) (n = 18) and CRT recipients (n = 27) followed continuously for 1\u201320 years. Pre-existing and any de novo Arr that occurred following CRT were documented. Clinical assessments were continuous. Results: Follow-up was for 1 to 20 y (mean 7.5 y \u00b1 0.7 sem). Patient demographics (CRT vs. MM groups) were comparable. Pre-existing Arr were found in 16 pts (38%) from both groups: accelerated junction (one CRT), atrial flutter (one CRT; two MM), and ventricular tachycardia (six CRT; six MM). During follow-up, outcomes included 14 pt deaths and 7 heart transplants (HTs). Of these, pre-existing Arr were causative among three CRT recipients: two \u2264 2 y and one &gt; 5 y after CRT. There were no new-onset Arr in any pt groups. CRT significantly improved patient survival free from HT or death at 10 y (44 vs. 13% [p &lt; 0001]). Conclusion: When applied effectively, CRT benefits CHD-HF pts without causing additional arrhythmias. However, pre-existing Arr remain a concern reflecting persistently adverse intrinsic myocellular issues among CHD-HF pts.<\/jats:p>","DOI":"10.3390\/jcdd13030117","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:11:36Z","timestamp":1772629896000},"page":"117","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Resynchronization Pacing Proarrhythmic Among Congenital Heart Patients? An Evaluation and Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2278-9167","authenticated-orcid":false,"given":"Peter P.","family":"Karpawich","sequence":"first","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Zelin","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinne","family":"Biggs","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swati","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-3915","authenticated-orcid":false,"given":"Jennifer","family":"Blake","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenni","family":"Sriram","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooja","family":"Gupta","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Departments of Pediatrics, The Children\u2019s Hospital of Michigan, Central Michigan and Wayne State Universities Schools of Medicine, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00246-017-1787-2","article-title":"Systematic literature review on the incidence and prevalence of heart failure in children and adolescents","volume":"39","author":"Shaddy","year":"2018","journal-title":"Pediatr. 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